
Class 

Book ___ 



Rfto»ps\ 



Copyright^ . 



COPYRIGHT DEPOSIT 



Ill 




~Y~OUTH fades ; love droops; the leaves of friend- 
ship fall; 
A mother's secret hope outlives them all. — Holmes 



GUIDING HINTS 

IN 

OBSTETRICAL NURSING 

By 

MATTIE F. HOWARD, R. X. 

Graduate of the 

St. Louis Mullanphy Hospital 

Late head Nurse of St. Ann's 

Maternity Hospital 

St. Louis. Mo. 



^G\ 



Copyrighted 1912 by 
MATTIE F. HOWARD, R. N. 



€CI.A316953 



MOTHER. 

"To her care have been intrusted 
All the heroes of all lands; 
Still the fate of church and nation 
Holds she in her slender hands. 
Guiding wilful feet and faltering 
On through childhood's happy years, 
On through youth with its temptation, 
With its hopes, its doubts, its fears ; 
Cultivating all that's noble. 
Gently chiding all that's wrong. 
'Till her children gather 'round her. 
Men and Women, pure and strong. 
By the quiet ministrations. 
In the little realm of home. 
For the structure of the ages. 
She has laid the corner stone." 



To 

Frank A. Glasgow, M. D. 

Arthur N. Curtis, M. D., and Louie P. Butler, M. D. 

As an inadequate token of appreciation and esteem this 

little book is respectfully dedicated by 

The Author. 



PREFACE. 

The following lines are, as they imply, helpful sug- 
gestions in obstetrical nursing. They are guiding 
steps and g'entle reminders of knowledge already 
acquired. This little book is not intended as a text- 
book, but was written with a view of helping the 
young- nurse in private practice when first thrown upon 
her own responsibilities, in aiding her in remembering 
the important practical teaching of hospital training. 

While this little book is not intended as a text-book, 
the pupil nurse will, I am sure, find it helpful to her. 
and the inexperienced will find in its pages many help- 
ful suggestions to aid them in this very important and 
delicate branch of nursing. There are, also, to be 
found many useful hints for the expectant mother. 

I have prefaced my book with a description of the 
maternal organs, their position, structure and their 
each important function. Following this short chapter, 
a few lines upon the importance of the expectant 
mother placing herself under the care of the physician 
that is to care for her early in pregnancy; the neces- 
sity of the observance of hygiene during; this time, 
symptoms of pregnancy, and the changes in the ma- 
ternal organs during pregnancy. Following these 
chapters comes the very important one of labor; and 
in this chapter and the one that fo'low, I have en- 
deavored to take the nurse step by step from the be- 
ginning of labor to the complete recovery therefrom. 

7 



Showing her how she may be of assistance to the at- 
tending physician ; making notes of obstetrical and 
surgical complication and interference, with simple 
remedies that may be used in an emergency. Then 
follows a short chapter on the "Care and food for the 
baby." 

I have purposely avoided all medical and technical 
terms, using the simplest words to express the mean- 
ing intended to be conveyed, so as to make everything 
plain and comprehensible, and to avoid all doubt as 
to the meaning and method given. 

The hints herein contained are taken from lectures 
delivered at the Training School, and personal profes- 
sional experience. The author especially acknowledges 
her indebtedness to Frank A. Glasgow. M. D. ; Arthur 
N. Curtis, M. D.. and Louis P. Buttler, M. D., for many 
of the guiding* hints herein contained. 

THE AUTHOR. 



LIST OF ILLUSTRATIONS. 
Figure. Pa = e ' 

Frontispiece. Mother and Child. 

1. Female pelvis 1 • 

2. Female pelvis with ligaments, viewed from above 

( Diekerson > 18 

3. Female pelvis with ligaments, viewed from below. . . IE 

4. Female pelvis with bones separated 19 

Female organs of generation 20 

6. Formation of the decidua 21 

7. Formation of the decidua completed -1 

8. Mammary glands 24 

9. Corset pushing the child and organs down in the pelvis 31 

10. Massage of the nipple before child birth 3a 

11. Breast in pregnancy 41 

12. Striae gravidarum 42 

13. Varicose veins or the lower extremity in pregnant 

woman at term (Hirst » 44 

14. Obstetrical calendar 49 

15. Human embryos, from the second to the fifteenth 

week 

16. Combination of hor water bag and fountain syringe.. . 60 

IT. Infant's scales 61 

: 8. Diagram of baby's hammock, showing the different 

parts 

Baby's hammock completed 62 

Sterilizer 62 

21. Obstetrical leggins 63 

22. Nurse's or doctor's gown worn during labor 63 

23. Child in the uterus at the beginning of labor 67 

24. Diagram showing the advancement of the head 

through the pelvis i Lushman) 73 

25. Blanket with hot water bottle, awaiting the arrival 

of the little stranger 81 

26. Side view of fetus, showing the attitude it holds in 

the uterus S3 

9 



LIST OF ILLUSTRATIONS— Continued. 
Figure. Page. 

27. Front view of fetus, showing the attitude it holds in 

the uterus 83 

28. Patient prepared for doctor's external examination. . . 85 

29. Patient prepared for doctor's internal examination. . . 86 

30. Nurse curing cramps in leg during labor 89 

31. Diagram showing the method of tying and dressing 

the umbilicus cord and the binder applied. ........ 94 

32. Patient arranged for the conduct of the third stage 

of labor 97 

33. Nurse holding the uterus during the third stage 98 

34. Twins placenta, showing arterial anastomasis 99 

35. Patient obliquely in bed, draped with a sheet, pre- 

pared for external examination 115 

36. Nipple shield 117 

37. Proper position for nursing an infant, when lying 

down 120 

38. Proper position for nursing an infant, when sitting 

up 121 

39. Perfection douche and bed pan 127 

40. Vertex presentation (Pinard) 141 

41. Presentation of the breech 141 

42. Delivery of after coming head by flexion through 

seizure of lower Jarv 142 

43. Knee chest position 143 

44. Elevated Sim's position 144 

45. Ignatz Semmilweis, the discoverer of the cause of 

peurperal infection 151 

46. Breast bandage applied, showing front and side view. 155 

47. Breast bandage; diagram showing how to cut a jacket 

bandage from a straight piece 155 

48. Litholomy position 167 

49. Arrangement for bathing an infant 176 

50. The proper manner of carrying a baby 187 

51. The proper manner of holding a baby when giving it 

the bottle 199 

52. Nelson's siphon 201 

53. Langerfeld's sterilizer 201 

54. Granite pitcher 201 

55. Glass funnel 201 

56. Graduate measuring glass 201 

10 



LIST OF ILLUSTRATIONS— Continued. 
Figure. Page. 

57. Brush with wire handle for cleaning the bottles 201 

58. Food warmer 202 

59. The bottles 205 

60. Rubber nipples 206 

61. Resuscitation of asphyxiated infant 210 

62. Bird's method; first motion, expiration 211 

63. Bird's method; second motion, inspiration 211 

64. Sylvestor's method of performing artificial respira- 

tion; first motion, expiration 212 

65. Sylvestor's method of performing artificial respira- 

tion; second method, inspiration 212 

66. Infant prepared for circumcision 215 

67. Arrangement for the application of ice compresses 

to the eyes 219 

68. Arrangement for the irrigation of the eyes 220 

69. Soft rubber ear syringe 221 

70. Infant syringe for rectal injection 225 



11 



CONTENTS. 

OBSTETRICAL NURSING 

CHAPTER I. 

Preliminary consideiations. — Who should not marry. — 
Physical fitness.— Pelvic anatomy. — Pelvic deform- 
ity. — The organs of generation. — The ovaries. — The 
uterus, fallopian tubes, vagina, vulva, mammary 
glands. — The placental sack. — The umbilicus cord. — 
The amniotic fluid 17 

CHAPTER II. 
Pregnancy. — Medical supervision 26 

CHAPTER III. 

Hygiene of pregnancy. — The lungs. — Sleep. — Diet. — Drink. 
— Clothing. — Exercise. — Bathing. — The urine. — The 
bowels. — The kidneys. — The teeth. — Care of the 
nipples. — Swelling. — Vaginal cleanliness. — Conta- 
gious diseases. — Occupation 28 

CHAPTER IV. 

Symptoms of Pregnancy. — First symptom. — Second symp- 
tom. — Third symptom. — Fourth symptom. — Presump- 
tive and probable signs. — Positive symptom. — Rela- 
tive value of the signs of pregnancy. — Nausea and 
vomiting 37 

CHAPTER V. 

Changes in the maternal organism caused by pregnancy. 
— The blood. — Heart. — Breast. — Abdomen. — Uterus. 
— Bladder. — Bowels. — Veins. — Liver and spleen. — 
Cough. — Lightening. — Respiration. — Quickening. — 
The fatal heart. — The nervous system. — Nervous im- 
pressions. — The duties of her friends 40 



CONTEXTS— Continued. 



CHAPTER VI. 



Preparation for labor. — Duration of pregnancy — The ob- 
stetrical nurse. — Outfit of mother and child. — Outfit 
for the mother. — Outfit for the baby. — Selection of 
the room. — Sterilization, labor pack, instruments. — 
Cleaning the hands. — Other directions 4S 

CHAPTER VII. 

Labor. — The obstetrical bag of the nurse. — Recognition of 
labor. — False and true Jabor pains. — True labor 
pains. — False labor pains. — The different stages of 
labor. — Toilet of the patient for labor. — Preparation 
of the bed. — A good labor pad. — The use of the reins 
or tractor. — Directions for making the reins. — Prep- 
aration for the doctor. — When to send for the 
doctor. — Preparation for the reception of the baby. 
— The position of the child. — The duties of the nurse 
after the arrival of the doctor. — The preparation of 
the patient for examination. — For external examina- 
tion. — For internal examination. — The instruments. — 
Curing cramps in the legs. — How to administer the 
chloroform. — To make an inhaler. — To assist the 
doctor in preserving the perineum. — Tying the cord. 
— Preparation for forcep operation. — Baptism. — 
Third stage of labor. — Delivery of the placenta. — 
Douche after labor. — Lacerations. — The toilet and 
care of the patient immediately after labor. — The 
binder. — The occlusion bandage. — After pains. — Tem- 
perature and pulse 59 

CHAPTER VIII. 

The puerperal period. — Care of the mother after labor. — 
Sleep after labor. — Nourishment. — The position of 
the patient. — Involution. — Uterine contractions. — 
Bleeding. — Passing of urine. — Catheterization. — The 
bowels, — Drink. — Visitors. — Cleanliness. — Vulva 
dressing. — Sutures. — Ventilation. — Care of the breast. 
— Care of the nipples. — Dr. Arthur N. Curtis 
method. — Nursing. — Feeding the baby. — The posi- 
tion of the mother when nursing the child. — Position 
when lying down. — When sitting up. — Regularity in 
nursing.— How often to nurse the baby. — To in- 
crease the flow of milk. — To dry up the milk. — 
Mixed feedings. — The temperature. — The lying-in 
period. — Convalescing period. — Morning toilet of the 

13 



CONTENTS— Continued. 

patient. — How to change the patient's bed.— To 
change the bottom sheet. — To change the draw 
sheet. — To change the top sheet 106 

CHAPTER IX. 

Complications during labor. — Management of the birth of 
the child in the absence of the physician. — Tying 
the cord. — Delivery of the placenta. — Other presen- 
tations. — Breech presentations. — Arm or transverse 
presentation. — Prolapse of the cord. — Hemorrhage. 
— General direction. — Placenta praevia. — Post-par- 
tum. — Reoccurring. — Abortion. — Secondary hemor- 
rhage. — Symptoms of hemorrhage. — Eclampsia.... 132 



CHAPTER X. 

Complications of the puerperium. — Sepsis. — Engorgement 
of the breast. — Fissues and crack of the nipple. — 
Mastitis. — Puerperal insanity. — Paralysis. — Septic 
phlebitis. — Subinvolution 150 



CHAPTER XI. 

Points of special interest during puerperium. — Sleep. — 
Chill after labor. — Pulse. — Temperature. — Abdomen. 
— Uterus. — Appetite. — Skin. — Bladder. — Bowels. — 
Lochia. — Breast. — Lactation. — Chills. — The record of . 
the nurse 160 



CHAPTER XII. 

Obstetrical operations. — Pereneorrhaphy. — Forcep. — Ver- 
sion. — Cesarian section . 165 



CHAPTER XIII. 

Care of the baby. — Articles necessary for baby's bath. — 
Temperature of the room. — Temperature of the bath. 
— How to bathe the baby. — Care of the eyes. — Care 
of the mouth. — Care of the skin. — Care of the cord. 
— Care of the genitals. — Care of the nails. — Clothing. 
— How to dress the baby. — Sleep. — A bed for an 
infant. — How to put the baby to sleep. — Exercise. — 
Language of the baby. — Cry of pain. — Cry of hunger. 
— Cry of illness. — Cry of temper. — Cry of habit. — 
Normal cry. — How to lift and carry the baby. — 

14 



CONTEXTS — Continued. 

Temperature of baby. — Pulse and respiration. — 
Nervous babies. — Kissing the baby. — Bowels of baby. 
Character of the stools. — First few days. — Breast 
fed children. — Artificially fed babies. — Dark stools. 
— Regularity of habit. — Kidneys of the baby. — Air- 
ing 170 

CHAPTER XIV. 

Food. — Table showing the constituents of mother's and 
cow's milk. — Formula I. irom the first to :he four- 
teenth day. — Formula II. from second to the sixth 
week. — Formula III, from sixth to the twelfth week. 
How to feed :he baby. — How to prepare the lood. 
— Material needed. — Appliances needed. — To prepare 
the bottles. — The preparations of the formula. — 
Pasteurizing milk. — Sterilizing milk. — To heat milk. 
— To tell gcod milk. — The bottles. — The nipples. — 
Other foods. — The wet nurse. — Weaning the baby. 
— Water for the baby. — Weight of baby. — Keep :he 
baby clean 192 

CHAPTER XV. 

Ills of baby. — Asphyxia monatorum. — Artificial respiration. 
— Blue babies.— An improvised incubator. — My in- 
cubator. — Hemorrhage. — Delayed urination. — Circum- 
cism. — The bowels. — Jaundice. — Infection of the 
eyes. — Precaution to prevent infection. — Difficulty in 
nursing. — Vomiting. — Indigestion. — Colic. — Infection 
of the umbilicus. — Tetanus. — Hernia — Hiccoughs. — 
Thrush. — Engorgement of the breast. — Vaginal 
discharge. — Mens:ruation. — Size and weight at birth. 
Teething. — Convulsions 209 

APPEXDIX. 

The life of the nurse. — The duties of the nurse towards 

the physician. — The nurse and her patient _ 1 



15 



CHAPTER I. 
THE ORGANS OF GENERATION. 

"Man is fearfully and wonderfully made." 

In studying the subject of obstetrics it is important 
to understand something of the anatomy of the pel- 
vis, its adaption to childbirth, and the organs of gen- 




Fig-. 1 — Female pelvis. (Dickerson.) 

eration. The pelvis or bony frame work of the lower 



121 



17 



part of the body, so called from its resemblance to a 
basin. It is composed of four bones. The two os in- 




Fig. 2 — Female pelvis with ligaments viewed from above. 
(Dickerson.) 

nominata or hip bones, consisting" of the two ilia, two 
ischie and one pube, forming the sides and front, and 




Fig. 3 — Female pelvis with ligaments viewed from below. 

the sacrum and coccyx completing it behind. The 
pelvis is a bony basin without a bottom. The lower 

• 18 



opening is the inferior strait or outlet through which 
the child is propelled and finally expelled. These 
bones expand under pressure and during the greater 
part of the child bearing period there is more or less 
elasticity of the joints capable of being utilized dur- 




Fig. 4 — Female pelvis with bones separated. 

ing childbirth. Like other parts of the body, the pel- 
vis is often deformed which unfits a woman for ma- 
ternity. This deformity may be hereditary or due to 
injury or mode of living. The higher we go in civi- 
lization the more often do we find deformity present. 
Crooked bones and pelvic deformity may not serious- 
ly interfere otherwise with its relations with the rest 
of the body. But such a woman should not marrv, 
she cannot bring a child through a deformed pelvis 
without great danger to both herself and child. 



THE ORGANS OF GENERATION. 

The organs of generation are the two ovaries, the 

19 



two fallopian tubes, the uterus or womb, the vagina, 
the vulva, and the two mammary glands. 




Fig. 5 — Female organs of generation. (Beigel.) 
A, portio vaginalis; B, corpus uteri; C, fundus; D, Fallopian 
tubes; E, fimbriae; F. ovaries; G, parovaria; H, round ligaments: 
J, vagina; K, labia majora; L, labia minora; M, clitoris: N. hy- 
men. (Beigel.) 



The Ovaries. 

The ovaries are two small bodies, white in color, 
situated in the pelvic cavity, on each side of the uterus, 
on the posterior surface, just below the fallopian 
tubes. They are the size and shape of a flattened 
pigeons eg-g\ They are composed of small vesicles 
called the graffican follicles, which contain a smaller 
vesicle called the ovum, from which the whole body 
is developed when the ovum is fecundated. The rip- 
ened human ovum is a highly developed spherical cell 
about 1-125 of an inch in diameter. It is enclosed in a 
thick membrane called the A'etalline membrane. 
Within the membrane or cell wall is the protoplasm 
of the cell, filled with fatty and albumious granules, 
and is called the vitellus or yoke. Imbedded in the 

20 



vitellus is a transparent nucleus (the germinal vesi- 
cle). In this germinal vesicle is a small nucleus, the 
germinal cell. Remember a cell is a minute portion 
of living substance called protoplasm. At the mo- 
ment of rupture the ovum is discharged into the 
ovary. After the ovum reaches certain stages of 
development it is discharged from the ovary into 
the fallopian tubes, and passing through this canal 
it is conveyed to the uterus. If the ovum is impreg- 
nated it is retained within the uterus, and the moment 
the ovum is impregnated by the male cell, life takes 
place. Upon the arrival of the ovum in the uterus it 
is grafted upon the mucus membrane. It usually 
lodges upon the upper surface of the side of the uterus, 
between two folds of mucus membrane. When the 
ovum passes from the fallopian tubes to the uterus 
it finds the mucus membrane prepared by certain 
changes t o receive 
it. The m u c u s 
membrane becomes 
thick a n d soft and 
furnishes the mem- 
brane known as the Fig "- 6-Formation of the decidua. 
decidua. About the third month there develops be- 





Fig-. 7 — Formation of the decidua completed. 

21 



tween the fetal sack and the wall of the uterus, the 
placenta. It is formed for the protection of the em- 
bryo. 

The Placental Sack. — The child is enveloped in a 
sack with a double wall. The amnion inside, the cho- 
non outside. This sack resembles a flat cake. The 
umbilicus cord is inserted on one side and the other 
side of the placenta is attached to the inner surface 
of the uterus. The mother's blood flows in and 
around the placenta. After the birth of the child the 
placenta is separated from the wall of the uterus and 
expelled. It is about seven inches in diameter and 
one inch in thickness, weighing* about sixteen ounces. 
The Placental blood vessels are the two Umbilical 
arteries, and one umbilical vein which extend from 
the placenta through the umbilicus cord and are 
continuous with the circulatory system of the fetus. 

The Umbilicus Cord. — The umbilicus cord is com- 
posed principally of these vessels, namely, the two 
umbilicus arteries and one umbilicus vein and a pe- 
culiar substance known as the jell}- of Y\ narton. It 
is about tAventy inches long and a half an inch thick. 

The Amniotic Fluid. — The placental sack contains 
a fluid known as the amniotic fluid. In this fluid the 
fetus floats during its intrauterine life. It is formed 
for its protection. It protects it from sudden jars and 
shocks. The origin of the amniotic fluid is not known, 
the most probable supposition being that it is simply 
exuded from the tissues of the fetus. After the for- 
mation of the placenta, a capillary network, connect- 
ed with the vessels of the umbilicus cord, is developed 
just beneath the amnion in that portion of the chor- 
ion which covers the placenta. From these vessels a 
transudation of serum takes place into the cavity of 

22 



the amnion. The increased amount of fluid in the am- 
nion in the later months of gestation is possibly due 
to the accumulation of urine which the fetus passes 
from time to time during intrauterine existence. The 
amniotic fluid contains in addition to water, albu- 
men, urea and salts which are found in serum and 
urine. This fluid is a great tactor in the first stages 
of labor. First it dilates the cervix and the vagina 
gently and eA^enly. It protects the baby from injuri- 
ous pressure on any one part. When the uterus 
contracts the pressure on the fetal sack is even, and 
after rupture it lubricates the passage, making the 
child descend with less effort, and if there is infec- 
tion in the vagina it washes it out, and prevents it get- 
ting into the baby's eyes. 

The Fallopian Tubes. — The fallopian tubes are 
two in number, situated on each side above the ovary. 
They are of reddish glistening color, resembling a 
trumpet, the expanded end over the ovary, and the 
other at the upper end of the uterus. They are hol- 
low muscular canals, about three inches long which 
every month convey the ovum into the uterus. 

The Uterus. — The uterus is a muscular flattened 
pear-shaped organ, two and a half inches long, one 
and a fourth inches wide, and three fourths of an inch 
thick, weighing from two to two and a half ounces. 
Situated in the middle of the pelvic cavity, behind the 
bladder and in front of the rectum. The small in- 
testine rest upon it. It is held in position, mainly, 
by two large folds of peritoneum called the broad 
ligaments, and two rounded fibro-muscular cords 
called the round ligaments, and the tissues below. 
It is freely movable in all directions. The upper 
angles are called the horns or cornea, and receive the 

23 



fallopian tubes. The lower part is called the neck or 
cervix. A portion of this protudes into the vagina 
and presents an orifice called the os, which leads into 
a cavity in the interior of the uterus. 

In the virgin it is a very tense organ, weighing 
about two ounces, but when pregnant it increases im- 
mensely in size and capacity. 

The Vagina. — The vagina is a curved muscular 
membranous canal situated in the pelvis, extending 
from the vulva to the uterus, and is very dilatable. 
Its walls are composed of mucus membrane and mus- 
cular fibrous coats, and it is supplied with lymphat- 
ics, blood vessels and nerves. 

» 

The Vulva. — The vulva is the external orifice of the 
female organ: 




Fig. 8 — Mammary glands. 
Mammary gland. a, nipple, the central 
which is retracted; b, areola; c, c, c, c, c, lobules ottne 
sinus or dilated portion of one of the lactiferous ducts: 2 
ities of the lactiferous ducts. (Liegeois.) 

24 



portion 



of 

i, 
extrem- 



rland 



The Mammary Glands. — The mammary glands are 
the large racemose glands which secrete the milk. 

Thus we will see how closely connected, and how 
important the function of each organ is. The ovary 
furnishes the ovum or germ from which the new crea- 
ture is created, the fallopian tubes receives this germ 
and convey it to the uterus, and in the uterus the 
germ obtains the nutritive material necessary for its 
life, growth and development. 



CHAPTER II. 

PREGNANCY. 

Pregnancy begins with conception and terminates 
with the expulsion of the foetus and membranes. 

Medical Supervision. — The expectant mother should 
place herself under the care of the physician, who is 
to attend her during- labor, in the early days of gesta- 
tion, or as soon as she is aware of her condition, or 
has a belief as to its probability, as a certain degree 
of professional advice and attention is required dur- 
ing- the whole period of pregnancy, and never later 
than three months before delivery. The last three 
months constitute the most critical period in the life 
of the expectant mother, and she should be under the 
constant care of her physician during these months 
and consult him upon the least indisposition; while 
the condition, as a rule, is merely weakness, the bor- 
derland between health and disease may be very easi- 
ly overpassed. At any time disorders or complica- 
tions may occur. These in all probability can be 
promptly remedied by the physician's watchful care 
and treatment. He will then be in a position to for- 
see, and in all probability, to prevent the occurrence of 
serious complications at the time of labor. The ob- 
stetrical patient is often neglected, both in regard to 
her medical attendance and her nursing. Often se- 
lecting the physician whose fee is small, or worse 

26 



still, an ignorant midwife or some monthly nurse, 
entirely forgetting that conditions and complications 
may arise in which to save the life of mother or child. 
or both, would require the highest obstetrical skill. 
The obstetrical patient should secure the best ac- 
coucher possible; he should be a physician of experi- 
ence and reputation, also, select the best obstetrical 
nurse obtainable. Use the same care as one would 
use in selecting a surgeon and nurses for a surgical 
operation. For the danger is great, and there are two 
lives to be considered. During the last three months 
an examination should be made to ascertain the po- 
sition of the child's head and the presenting part, and 
to make sure if any complications exist. Also, to 
learn the relative size of the pelvis of the mother and 
the head of the child. So a patient will readily see 
how necessary it is to be careful in selecting her phy- 
sician early in pregnane)'. 

The mother thus guarded, and her condition care- 
fully watched by a skillful accoucher, with a compe- 
tant obstetrical nurse to take care of her after labour, 
there is little cause for fear but that she will pass 
through the ordeals in perfect safety. The mother's 
whole duty is now to herself and her child, nothing 
should be allowed to interfere with the well being of 
either. 

"Every child has the right to be born well." 



27 



CHAPTER III. 

HYGIENE OF PREGNANCY. 

The study of Hygiene is an old study ; it dates back 
to ancient times. It was the practice of the ancient 
Greeks and Romans; not as practiced today, but for 
specific reasons. "Hygiene,'' the goddess of health, 
and as the word signifies 'To make beautiful;'" the 
science of health and its preservation, and as taught 
today is quite a modern science, broadening and wid- 
ening our duty as nurses. It is easier to keep people 
well than to cure them after they are sick. This 
is particularly true of the obstetrical patient. The 
health of the patient is a matter of great importance 
during the pregnant state. Health as we are taught 
is that perfect condition of an individual in which all 
parts of the wonderful body act in perfect harmony, 
freedom and uniformity, and in which there is a per- 
fect balance between waste and repair, between the 
outpour of energy in work, and the intake of energv 
in food. Between the quantity and quality of solids 
and fluids taken in and thrown off by the body each 
day. Health is a body state of perfect harmony ; the 
perfect circulation of pure blood in a sound organism. 
The most essential rules to be observed during the 
pregnant state is to keep all the organs in a good 
health}- condition that they may accomplish the ex- 
tra work required of them. This is accomplished 
by living in a healthy natural manner ; having regu- 
lar hours for meals and sleep : daily exercise in the 

28 



open air ; comfortable clothing ; avoidance of exhaus- 
tion and great muscular exertion ; frequent bathing ; 
freedom from worries. The patient should not fret, 
but keep herself occupied by light and pleasant work. 
During the pregnant state the increased elimination of 
waste material which must be thrown off by the 
mother, both for herself and the developing child, 
throws extra work on the various organs of the body. 
The greatest strain falls on the eliminative organs. 
Those organs that dispose of waste materials found 
in the blood are the lungs, the skin, the liver, the bow- 
els and the kidneys. As these organs dispose of waste 
products they should receive special attention. 

The Lungs. — During pregnancy the increased elimi- 
nation of carbon dioxide by the lungs is necessarily 
associated with an increased consumption of oxygen. 
This respiratory activity makes an abundance of fresh, 
pure air at all times a matter of great importance. 
Small, close, over-heated or crowded rooms are to be 
avoided, also, confinement indoors. The patient 
should have all the fresh, pure air possible. 

Sleep. — Regular and abundant sleep is required by 
the pregnant woman — at least eight hours — and a 
nap should be taken in the afternoon, or if the patient 
is unable to sleep the time should be spent quietly 
resting on the bed. Avoid entertainments, theatrical 
parties and all social engagements which necessitate 
late hours, irregular meals or excitement. 

Diet. — Xo absolute rule or list can be given as the 
same foods do not agree with or appeal to all patients. 
But generally little if any change is necessary in the 
diet. It should, however, embrace all nutritious and 
easily digested articles of food. A normal supply of 

29 



nutritious food improves the blood supply ; increases 
functual activity, and aids in the healthy develop- 
ment of the fetus. The food should be plain and nour- 
ishing- and easily digested and of sufficient quantity. 
The mother must take nourishment for the develop- 
ing child as well as for herself. Milk, soft-boiled eggs, 
fresh ripe fruit in season, fruits cooked with very lit- 
tle sugar, with plenty of well cooked vegetables and 
red meat but once a day. These articles should form 
the basis of the diet. Fruits are valuable because of 
their laxative properties, and their stimulating action 
upon digestion. Fried dishes, pastries, unusually 
highly seasoned or very rich dishes, and sweet meats 
of all kinds are to be avoided. There is, during preg- 
nancy a natural tendency to digestive disturbance, 
which is apt to be increased by rich food. Any actual 
craving- for certain things should be submitted to the 
physician before it is yielded to. The appetite is natur- 
ally somewhat increased during this period, but 
should be kept within bounds. Over eating should be 
avoided. 

Drink. — The patient should drink an abundance of 
pure cool water, at least from live to seven glasses 
daily. It washes the stomach, flushes the kidneys 
and assists these organs to get rid of waste products. 
Best taken before meals, an hour before eating and at 
bed time. If taken during- meals it dilutes the diges- 
tive juices and reduces the temperature of the stomach 
and thus retards digestion. The water may be cool 
but not ice cold. Ice cold drinks are very injurious 
and should be avoided. Soda, orangeade, and lemon- 
ade are permissible. But beer, wine and all alco- 
holic stimulants are forbidden except by order of the 
attending physician. 

30 



Clothing. — The clothing should be loose and suit- 
able for the season of the year. The underwear should 
be of wool even in summer. The drawers should be 
long reaching to the ankles. Wool is recommended 
in place of cotton, linen or silk because it absorbs 
the presperation as rapidly as it is formed and keeps 
the skin free from moisture and thus prevents chill- 
ing of the body. It keeps the vital organs warm and 
protects them. The clothing should be supported 
from the shoulders, which is the best method, and not 
from the waist, as too much pressure and weight is 
brought to bear on the chest and abdomen. Corsets 
should be discarded early in pregnane}-, as they in- 
terfere seriously with the development of the child, 
they also hinder the action of the mother's heart and 
lungs, resulting in the improper oxygenation of blood 
for the requirements of both mother and child. This 
is especially true if worn tight. 
To lace to hide and conceal her 
true condition is foolish and 
wrong and may result in seri- 
ous injury to both mother and 
child. Where the weight is 
very great and the patient feels 
the necessity of support, an 
abdominal bandage may be 
worn with the permission of 
the attending physician. Gar- 
ters which encircle the legs j* 
should also be discarded, as X^ y.<";- ; 

they interfere with the circu- W 

lation of the lower extreme- 
ties. The stockings should be 

i-i ~ . Fig. 9 — Corset pushing the child 

pinned With Satetv pillS, Or and organs down in the pelvis. 

side suspenders or supporters worn. 

31 



T 



"\.;v 



Exercise. — Regular daily exercise in the open air 
should be taken each day, and never omitted except 
when the weather is very bad. The best form of ex- 
ercise is walking. The length of the walk will de- 
pend on the strength and condition of the patient. A 
walk in the sun-light will often promote sleep. If un- 
able to walk, a pleasant drive over a smooth street 
may be taken. Care must be taken not to over do it, 
and the patient become fatigued. Women miscarry 
most often at the third and seventh months. Women 
prone to miscarriage should observe care at the time 
that would correspond to the occurrence of the men- 
strual periods. Fatiguing exercise and great mus- 
cular efforts may prove disastrous. Violent excite- 
ment of any kind should be avoided. 

Bathing. — The skin should be kept in a healthy 
condition by frequent bathing. A daily bath should 
be taken during the summer months, and twice a 
week during the winter months. The water should 
be warm, not hot or cold. Shower baths and sprays 
are never permitted during pregnancy. Baths are 
best taken upon retiring-, as there is less danger in tak- 
ing cold, they are restful and promote sleep. Thus 
by frequent bathing the skin is kept in a healthy 
condition, and by its elimitive action relieves the 
kidneys of some of the work they have to do. Dur- 
ing the last two months of pregnancy, a daily appli- 
cation of olive oil to the skin, especially to the abdo- 
men, vulva and perineum aids greatly in the pre- 
vention of tear from the distention of labor. It les- 
sens the amount of scar tissues to be seen on the ab- 
domen after pregnancy. 

The Urine. — The urine should be examined from 
time to time in order to detect the first approach of 

32 



that very dangerous condition termed "albumenuria 
of pregnancy," which often causes the death of the 
mother and child, by convulsions. 

The Bowels. — Normal evacuation of the bowels 
once daily should be the rule. If constipation presist 
the patient should consult her physician who will re- 
lieve her and adjust matters by some simple laxa- 
tive. The use of active purgative pills cannot be too 
strongly condemned. 

The Kidneys. — The kidneys during these months 
should receive special attention. The first decided 
evidence of disease or faulty metabolism is often found 
in the urine. Hence it is of the utmost importance 
that an examination of the urine should be made at 
the regular intervals in order that any such disturb- 
ance may be discovered in time and corrected. Once 
every month ascertain the quantity of urine passed 
during the twenty-four hours. Should it fall below 
forty-live ounces, it should be increased by drinking 
more water. Should this fail to increase the quanti- 
ty the physician's attention should be called to it. 
Of course, the time of the year and the execretion 
of the skin are to be considered. A specimen of the 
mixed twenty-four hours urine should be sent to the 
physician in charge of the case once a month during 
the first six months, and twice a month during the 
last three months of pregnancy. Accompanying the 
specimen should be an accurate statement of the 
amount passed during the twenty-four hours. The 
examination of the urine is very important and should 
not be neglected. Neglect in some cases might cause 
serious trouble, and progress to such an extent as to 
produce a fatal termination, via, nephritis, uremic 

[3] 33 



poisoning and eclampsia. Toxameia in pregnancy 
is caused by the eleminative organs not doing their 
work properly. While these cases are comparatively 
few. no one can tell in which case this dangerous 
condition will arise. The only safe way is to treat 
each case with careful supervision, then the depart- 
ure from health can be treated on rirst appearance 
and serious trouble aA'erted. "Vigilance is the price 
of safety." The bottle should be surgically clean 
which is to receive the specimen for the doctor's ex- 
amination. That is the bottle should be washed clean 
and then the bottle and cork boiled live minutes be- 
fore using. It should hold at least three ounces ; be 
tightly corked, and bear the date, name and address 
of the patient. Care should be taken to have the ves- 
sel surgically clean in which the urine is passed, 
and the external parts should be well cleansed. 
Washing well with soap and water before passing 
the urine. The kidneys are the weakest spot of the 
patient during pregnancy and deserve special atten- 
tion. 

The Teeth. — The teeth require special care during 
the pregnate state, as the salvia is more acid and the 
teeth decay more rapidly, and are often very sensi- 
tive, causing much suffering. There is an old saving 
"For every child a tooth." They should be cleansed 
in the morning", after each meal and upon retiring at 
night. Brushing them and rinsing the mouth well 
and thoroughlv with a weak antiseptic, after which 
a little milk of magnesia taken into the mouth and 
allowed to cover and float around and over the teeth.. 
This forms a film or coating which will protect them 
from the acid action of the salvia, thus preventing ir- 
ritation and helps to preserve them. Should the teeth 

34 



become sensitive or the gums sore, the physician 
should be consulted. A tablespoon of lime water taken 
several times a week has been recommended. All 
small cavities should be filled. Large ones cleaned and 
temporarily filled, but no long tedious gold fillings or 
bridge work should be attempted during pregnane}'. 

Care of the Nipples. — During the last four weeks of 
pregnancy, the nipples should be washed with a bor- 
ic acid solution, a tablespoonful to a pint of water. 
At night apply an ointment of cocoa butter or white 
vaseline. In the morning it should be removed with 
warm water, soap and a soft brush. This process 
helps to toughen them and prepare 
them for nursing. If they are small 
or sunken, they should be kneaded 
and manipulated and gently drawn 
out with the thumb and index finger 
so as to lengthen them, and the phy- 
sician's attention called to it. It is 

. . , F i g-. 10 — Massage 

very important that the breast re- Q f the nipple. Be- 

ceive the necessary care to enable fore child birth. 
them to perform their important function. 

Swelling. — Should there be any swelling of the face, 
hands or feet ; any headache or vomiting or disturbance 
of the sight, the physician should be informed immedi- 
ately. 

Vaginal Cleanliness. — During the first weeks and the 
last two or three weeks of pregnancy, there is an in- 
creased vaginal discharge, and it is very important that 
the external genitals should be kept daily cleansed to 
prevent irritation. Vaginal douches should not be tak- 
en except by orders of the physician in attendance. If 
used at all the}' should be warm ; not hot or cold. 

35 




Contagious Diseases. — Avoid coming in contact with 
contagious diseases, diphtheria, scarlet fever, small 
pox, etc. Avoid, also, unsightly objects, fright or lift- 
ing heavy articles, running a sewing machine, overhead 
reaching, such as hanging up clothes, reaching to get 
an object from a shelf, and a pregnant woman should 
be careful and not lift young children. There is as much 
danger in lifting a heavy child as in lifting any other 
heavy article. Any discharge of blood, no matter how 
slight, occurmg any time during pregnancy, is a warn- 
ing to go immediately to bed, keep quiet, and send for 
the physician at once. 

Occupation. — The patient should keep herself en- 
gaged in some pleasant, light and useful work which 
will give exercise to the muscles and occupy the mind. 
such as light house work, sewing and fancy work. The 
work must not be pushed to fatigue. She should be 
very careful not to expose herself in any way so as to 
take cold. Avoid wet feet. Neglect may be serious. 



36 



CHAPTER IV. 

SYMPTOMS OF PREGNANCY. 

First Symptom. 
Among the early phenomena of pregnancy many 
patients experience the first month a nausea and at 
times vomiting. This is experienced usually as soon 
as the patient awakes or attempts to arise from her 
bed. hence it is termed "morning sickness." It is due 
to the spasmodic contractions of the stomach and dia- 
phragm, a sympathetic disorder reflected upon the 
uterus. This, it is claimed, is due to our mode of liv- 
ing, that it is unknown in savage life. As this condi- 
tion usually occurs on awakening in the morning, a 
little food, a cup of tea and a cracker taken before aris- 
ing often relieves this uncomfortable condition. If it 
occurs later during the day it is often relieved if the 
stomach is promptly emptied. The nausea usually 
ceases after the fifth month when the uterus rises 
above the brim of the pelvis into the abdominal cavity. 
If it continues after the fifth month it is due to either 
indiscretion in diet or toxaemia. There are cases in 
which this condition becomes serious. Any marked 
vomiting should be reported to the physician and the 
treatment left to him. There is usually more of a 
nausea than actual vomiting. Very few pregnant 
women escape altogether digestive disturbance. 



Second Symptom. 
The cessation of the menstrual flow is usually a sign 
of pregnancy, although not a positive one. It is, how- 
ever, of great importance where pregnancy exists in 
furnishing the physician with the only reliable guide 
for the calculating the probable date of delivery. 

Third Symptom. 

The breast enlarges and there is a pricking sensa- 
tion. They are very sensitive to the pressure of cloth- 
ing, and after the third month they contain a thin 
fluid, collostrum. is present and can be squeezed out. 
The nipples enlarge and have a soft feel, and the 
Areola becomes darker. 

Fourth Symptom. 

The softening of the neck of the uterus. The vulva 
assume a purplish blue color, owing to the dilata- 
tion of the veins. The abdomen changes in size and 
shape. 

Presumptive and Probable Signs. 

These are presumptive and probable signs or symp- 
toms. 

Positive Symptoms. 

Any and all of the above symptoms may be present 
in uterine tumor. The only positive proofs and 
symptoms we have are palpitation of the fetus, fetal 
movements, the recognition of fetal parts and the fetal 
heart tones. The beating of the fetal heart can be 
heard about the fifth month. Faint at first but gets 
stronger as pregnane}" advances. 

These are the only positive signs of pregnancy. 

Relative Value of the Signs of Pregnancy. 
First : The presumptive evidence of pregnane}" are 

38 



menstrual suppression ; morning sickness and irrit- 
able bladder. 

Second. The probable evidence are breast 
changes ; abdominal changes in size, shape and color ; 
also changes in the color and consistency of the neck 
of the uterus. 

Third. Positive signs of pregnancy are active 
movements of the foetus; passive movements of the 
fetus ; and the fetal heart sounds. 



39 



CHAPTER V. 

CHANGES IN THE MATERNAL ORGANISM 
CAUSED BY PREGNANCY. 

The general changes of pregnancy depends upon the 
changes in the blood and nervous system. 

The Blood. 

The blood changes in composition and increases in 
quantity. The watery element, white corpuscles and 
fibrim increases, its albumen and red corpuscles de- 
creases. Its clotting power is augmented. 

The Heart. 

The heart, having more work to do, increases one- 
fifth in weight. There is often palpitation, caused in 
the earh' stages from a sympathetic condition, in the 
later stage by the enlarged uterus. 

The Breast. 

During pregnancy the breasts undergo a change in 
preparation for their functual activity. They increase 
in size and present characteristic changes in structure. 
They begin to enlarge as early as the second month 
and after the third month they contain a thin fluid 
known as colostrum. The superficial veins enlarge 
and form a blue tracery beneath the skin. The nip- 
ples become elongated and prominent and increases 

40 



in size and are sensitive and have a soft feel. The 
areola becomes darker, and the papilla around the 




Fig. 11 — Breast in pregnancy. 



nipple becomes prominent, and the development of 

iular tissue 
At times they are very pain- 



the follicles and grandular tissue which gives the 

breast a knotty feel 

fill. 

The Abdomen. — The abdomen increases in size to 
accommodate the enlarged uterus, but this is not 
noticed until about the fifth or sixth month. In the 
sixth month the uterus reaches the umbilicus or 
navel, and in the eighth month it reaches the end of 
the sternum or breast bone. During the last two 
weeks of pregnancy the uterus sinks somewhat into 
the pelvic cavity. About the fifth month the navel 
begins to diminish in depth and about the seventh 
month becomes level with the skin. During the last 
two months the navel is often protuberant, caused 
by pressure of the uterus which forms a rounded 
elevation. Another condition of the abdomen is the 
stretching of the abdominal walls which result in 
the later months of pregnancy- in the formation of 
reddish, bluish and white sflisteninsr streaks (strias) 



41 



in the skin covering the sides of the abdomen, thighs, 
and breast, which do not disappear after delivery 




Fig*. 12 — Striae gravidarum. 

but lose their coloring leaving white scars on the skin 
This condition is found in over ninety percent of preg- 
nant women. They are due to an atrophic condi- 
tion of all the skin layers, and obliteration of the 
lymph spaces. There is a displacement and partial 
rupture of the connective tissue of the deeper layers 
of the skin. The great stress and stretching of the 
abdominal wall causes the different layers of the skin 
to waste or die. as it were, for want of nutrition. This 
is true, not only in pregnancy, but in any disease 
which causes the same condition, as Tumor or 
dropsy. Where ever pigment is found normally it is 
increased. Thus there is often a deep brown line 
running from the umbilicus to the pubes. 

42 



The Uterus. — The uterus changes in size and shape 
to accommodate the growing fetus, and about the 
fourth month contractions are felt. The neck is soft 
to the touch, and the vulva assumes a purplish blue 
color, owing to the dilatation of the veins, The ex- 
ternal generatives organs are, also, much more de- 
veloped and prominent. 

The Bladder. — The bladder is diminished in size 
caused by the increased size of the uterus, and as a 
consequence there is an increased frequency of 
urination. Albumen in the urine is not an infrequent 
occurence, due probably in mild cases to a transitory 
catarrh of the bladder, more common in the latter 
than in the beginning of pregnancy. Glucose ( sugar) 
is, also found. The urine increases in quantity 
and is of a low apecific gravity. 

The Bowels. — The bowels are usually constipated 
caused by the enlarged uterus pushing them to each 
side in such a manner as to compress them. 

The Veins. — Edema of the legs and feet, and en- 
largements of the veins of the legs, rectum and vulva 
are very common during the latter months of preg- 
nancy ; due to pressure and increased vascular full- 
ness of the pelvic vessels induced by pregnancy. If 
accompanied by a scanty secretion of urine, severe 
headaches and great disturbance of mind, it is a ser- 
ious symptom, and should be reported to the phy- 
sician in charge of the case at once. But if there is 
no suppression of urine, no mental disturbance or 
depression, and so long as the veins themselves are 
not involved they are of little importance. Thev are 
often, however, the seat of much suffering. Under 

43 



these conditions the patient should be massaged sev- 
eral times a week by a competent Masseuer, and this 




Fig-. 13 — Varicose veins of the lower extremity in a pregnant 
woman at term. (Hirst.) 

painful and uncomfortable condition can be entirely 
overcome. 

The Liver And The Spleen. — Enlargement of the 
liver and the spleen are often present during preg- 
nancy. The latter is caused by its relation to the 
circulatory system. 

Cough. — In the earlier months there is often a 
sympathetic nervous cough. 

Lightening. — About two weeks before delivery the 
Uterus sinks somewhat downward into the pelvis, 
while the fundus falls forward. This is termed 
lightening. When the head of the fetus sinks into 
the pelvic cavity. This change of position is followed 
by considerable relief to the respiration, at the same 
time there is experienced an increased difficulty in 

44 



locomotion, caused by the presenting part descending- 
low in the pelvic cavity. This pressure, also, on the 
bladder causes frequent urinations. 

Respiration. — During the latter part of pregnancy 
the respiration is somewhat embarrassed and a state 
of dyspnea is present, caused by upward pressure on 
the diaphragm by the enlarged uterus ; and as the 
mother must supply more blood the lungs are very 
active eliminating carbon dioxide and absorbing 
oxygen so there is considerable relief experienced 
when the pressure is removed by the presenting part 
sinking low in the pelvic cavity a few weeks before 
delivery. The pressure upon the Lungs becomes less, 
so that the difficulty in breathing is removed. 

Quickening. — There is another condition which ap- 
pears about the middle of pregnancy, the eighteenth 
week, and it is termed "quickening." It is the earliest 
movement of the fetus preceived by the mother, when 
she first feels life. The sensation at first is compared 
to the flutter of a little bird held in the hand, but the 
movement becomes stronger and increases in intensity 
as pregnancy advances. In young mothers these 
movements often cause anxiety, they are painful and 
annoying. If they continue the physician in charge, 
of the patient should be consulted. 

The Fetal Heart. — We may have all of the above 
described conditions and still not pregnancy. But 
the one positive proof we have is the beating of the 
fetal heart. It is usually heard about the fifth month 
through the stethoscope. It can be heard later in 
pregnancy by applying the ear to the mother's ab- 
domen. This furnishes conclusive evidence of preg- 
nancy. The position and place we hear the heart beat- 

45 



ing often aids us in determining the position of the 
child There are some positions, however, in which 
it is quite or entirely absent, via. when there is a 
great deal of adipose tissue, the walls of the mother's 
abdomen are very thick, or where there is a laree 
amount of amninotic fluid, and in some positions 
of the fetus. It has been compared to the tic-toe of 
a watch and ranges from one hundred and twenty to 
one hundred and fifty beats per minute. It is easy to 
distinguish from the mother's pulse, and when clear- 
ly heard is the positive proof of the presence of a liv- 
ing child. 

The Nervous System. — The nervous system under- 
goes a change. A woman during this period is more 
subject to nervous influences and should be ke . 
quiet. The most amiable, loving and sweet tempered 
women are apt to become cross, fretful unreasonable, 
irritable and despondent. The spirits are often de- 
pressed and melancholy in women predisposed to in- 
sanity may terminate in mania. But for the sake of 
both her child and herself she must try and overcome 
this tendency. Despondency is sometimes caused by 
indigestion or the accumulation of waste products in 
the blood. This the physician can relieve. On the 
other hand there are women who are very delicate 
and frail, nervous and irritable : and very disagreeable 
under other circumstances that experience a sense of 
well being, and are very happy and pleasant during 
the entire period of pregnancy. The salivary secre- 
tions is increased. Neuralgia affection of the face and 
teeth are common. Pregnancy tests the integrity of 
every organ in the body. 

Nervous Impressions. — Nervous impressions of the 
mother rarely make impressions on the child, as the 

46 



fetus is completely funned at the end of eight weeks; 
but women should be careful during the early months 
of pregnancy to prevent miscarriges. Deformities in 
children are generally due to development of embr- 
yonic layers of tissue. 

The Duties Of Her Friends. — Her husband and 
those who are the immediate friends of the patient 
should do all they can to make her happy. Keep all 
that is unpleasant from her. and shield her as far as 
possible from all disturbing influence. Little enter- 
tainments that she can indulge in should not be over 
looked, and pleasant amusement to divert her mind. 
She should look forward to her delivery with joy and 
pleasure and not fear or dread. The better a woman's 
health and strength is during her pregnane}-, the bet- 
ter will she be able to pass through the ordeals of 
labor and perform the duties oi motherhood. 



47 



CHAPTER VI. 

PREPARATION FOR LABOR. 

Duration of Pregnancy. — In all calculations of the 
duration of pregnancy it is customary to assume as 
the starting point for the reckoning of gestation from 
the date of last menstruation. While the cessation of 
the menstrual period is not a positive sign of preg- 
nancy, it is a very important sign where pregnancy 
exists, as it is the starting point of gestation, and we 
count from that period. The duration of pregnancy 
is normally two hundred and eighty days, and we 
divide this space into ten (luna) months of twenty- 
eight days each, or nine (calender) months of thirty- 
one days each, or forty weeks. Another method is 
to add seven days to the date on which last menstrua- 
tion began and count forward nine months of thirty- 
one days each. The date thus obtained is said to be 
usuallv correct within a week. Naegele gives the 
following rule to compute this period: ''Count for- 
ward nine months from the first day of last menstrua- 

48 




Fig-. 14 — Obstetric calendar devised 
by Dr. Wm. L. Kantar of New York 
will be found useful to nurses in cal- 
culating date of expected labor. 



tion or backward three months, and add seven days 
After February in 
leap-year add six 
days." As for ex- 
ample, September 
1st, was the first day 
of last menstruation, 
count backward 
three months, which 
gives June 1st, add 
-even days which 
gives June the 8th. 
as the expectant day 
of confinement. In 
first pregnancies, 

or as we say, in case of primparae, labor is 
apt to begin a week or ten days earlier than 
this, as the uterus is not so tolerant of distention 
as it may afterwards be in later pregnancies. These 
are not always reliable guides, but are based on the 
theory that conception is most likely to take place 
just after the close of the menstrual period. "When 
the date of last menstruation cannot be obtained, 
we reckon the date of labor by adding twenty-two 
weeks to the date of quickening which is supposed 
to occur in the eighteenth week of pregnancy. It 
is the earliest movement of the fetus preceived by 
the mother, when she first feels life. But there is no 
rule or method which will insure accuracy in re- 
gard to the day on which labor will occur. The full 
term of pregnancy normally, is two hundred and 
eighty days. This may be prolonged to three hun- 
dred and yet be perfectly normal. 



4 



49 




Fig. 15 — Human embryos from the second to the fifteenth week 

The Obstetrical Nurse. — The nurse like the phy- 
sician should be engaged early in pregnancy, and 
the best obtainable should be procured. This delicate 
branch of the profession requires higher skill than 
an}- other form of nursing, comprising, as it does 
of surgical, medical and infant nursing combined 
For these reasons only the best nurses, those with 
special aptitude for this particular branch of nursing 
should adopt this specialty. A certain date is usually 
agreed upon from which date the nurse is paid her 
full salary, her time from that date is her patient's 
and she is subject to her call. It is better, if con- 



50 



venient for the patient; the nurse to be with her a 
day or two before expectant confinement, so as to 
see that everything is in readiness for the all impor- 
tant event. It is very desirable that the nurse sleep 
at the house at night after the time has expired, 
and baby is expected. 

Outfit For Mother And Child. — If previous arrange- 
ments have been made with the expectant mother, 
the nurse should make out a list of needed articles 
.so that ample provision may be made. The following 
list contains the essentials articles, but a more ample 
and elaborate one according to the means or taste of 
the mother may be given. The outfits may be divi- 
ded into two parts. One consisting of articles re- 
quired for the mother's use ; the other the articles 
needed by the baby. 

Outfit For The Mother. — For the mother is needed, 
one flannel wrapper or kimona of light material, 
six plain night gowns, four abdominal binders, one 
and one-half yards long by one half yard wide. These 
should be made of strong unbleached muslin. The 
length of the bandage differs with the size of the 
patent, according to her size. They should be torn 
the proper length and size and the selvage torn off; 
as this cuts and binds the tissue. Neither should 
they be hemmed. Leave the edges raw. 

Six breast bandages, the length differs according 
to the size of the individual. But should be at 
least ten inches longer than the measure around the 
bust to allow for the increased width upon the estab- 
lishment of lactation. The best bandages are those 
cut like a waist, with arm holes and fitted to the figure 
as shown in illustration. 

One dozen occlusion bandages or "swathe" to hold 

51 



the dressings in place. A good quality of outing- 
flannel makes the best bandage for this purpose. It 
is softer and more comfortable for the patient. These 
may be hemmed. They should be about one yard 
long and about ten inches wide. It is best to have 
the abdominal, breast and occlusion bandages laund- 
ered, as it makes them softer and more comfortable. 

Six draw sheets or large pads. These may be 
made of cheese cloth stuffed with cotton, nonabsor- 
bent or raw cotton, about two inches thick. They 
should be tacked to keep the cotton from slipping,, 
and when soiled can be burned. Or old clean sheets, 
folded together can be used for this purpose. Large 
quilted pads can be had at large dry goods stores 
they are excellent for this purpose. They can be 
laundered. The pads are used to protect the bed, the 
first three or four days when the flow is the greatest. 

Two pounds of good sterilized absorbent cotton, 
five yards of plain sterilized gauze in a glass jar. 
Many pieces of old clean cotton or linen cloths 
sterilized in the oven, for wiping the anus and per- 
ineum during labor. Many physicians prefer the 
sterilized old cloths to absorbent cotton for this pur- 
pose, six clean sheets, these should be as freshly 
laundered as possible, two dozen towels, old ones 
that are without fringe are the best, six dozen safety 
pins, four dozen large and two dozen medium size. 
three hand brushes that can stand boiling. The best 
are those with plain wooden backs, costing about 
ten cents apiece, one pint of alcohol, 95 per cent, for 
dressing the nipples, and to be used for the patient's 
comfort, four ounces of fluid extract of witch 
hazel, one douche pan, the perfection pan is best, 
a douche pan is preferable to a bed pan as it can 
be used for either purpose, one small granite pitcher, 

:^9 



holding about two pints, to use in giving the pitcher 
douches, one bottle of fluid soap, or six ounces of 
green soap, can be had at any drug store, three 
granite wash basins, a piece of rubber cloth, four feet 
by six feet for protecting the bed, white enamel oil 
cloth may be substituted for the rubber when 
economy requires, a piece of oil cloth for protecting 
the carpet by the side of the bed, or old newspapers 
may be used by spreading them out besides the bed 
a three quart fountain syringe, a hot water bag, a 
slop jar or bucket, a tube of white vaseline, one bot- 
tle, large size, of bichloride of mercury tablets, for 
making the solution, one pint of whiskey or brandy, 
one bottle of chloroform, fluid extract of ergot, three 
ounces, one pint of sterilized vinegar. Impress upon 
your patient the importance of having- this thoroughly 
sterilized, both jar and contents, to use in the non- 
contraction of the uterus or hemorrhage. If you 
have any doubts as to the proper sterilization of 
same, it is best to attend to it yourself. And when 
labor occurs there should be on hand six gallons of 
cool boiled water, and three gallons of boiling water, 
and ice in a convenient place in a basin of antiseptic, 
in case it is needed by the physician. Instruct your 
patient to have plenty of towels, sheets, pillow cases 
and gowns. It is so annoying to ask for these 
articles and find out there are none to be had. 
Especially towels. Have them within easy reach so 
if needed after labor can be had without confusion 

Outfit For The Baby. — For the baby will be needed 
a bottle of olive oil, six ounces, for annointing the 
baby immediately after birth, one pint of saturated 
solution of boric acid, to be had at any drug store, to 
use for baby's eyes and mouth. Dilute one-half 

53 



when using it. A piece of pure castile soap, one box 
of talcum powder, two soft sponges of different 
sizes, small one for the face, and larger size for the 
body, one skein of narrow linen bobkin tape, for 
tying the cord, Boric acid powder, three ounces, to 
use to dust around the cord and umbilicus after the 
cord is off, one soft hair brush for baby's hair, one 
powder puff, to brush off all superfluous powder 
from the body, or a little soft brush like the one used 
for brushing baby's hair is best, two large, soft bath 
towels, to wrap the baby in during its bath, four 
dozen cotton diapers. The cotton is prefered to linen 
as they are warmer and cheaper. They should be 
cut so they are twice as long as the}' are wide. As the 
"birdseye" comes in two sizes, it is well to have 
some of each. Several dozen large squares of old 
clean cloths to put in the baby's napkins the first 
few days until the intestinal track is entirely free 
of the meconium. These to be destroyed afterwards 
by burning. One soft woolen blanket to wrap the 
baby in immediately after birth, one bath tub or 
large wash bowl to use as a bath tub for the baby, six 
flannel binders, eighteen inches long and six inches 
wide, these like the mother's should have the selvage 
torn from them, unhemmed, and the edges left raw 
so as not to compress the tissue, four long sleeve 
flannel or silk shirts, six flannel pinning blankets, 
four flannel skirts, six night gowns, eight plain slips, 
two dozen safety pins, one dozen smallest size and one 
dozen medium. The foregoing wardrobe is the small- 
est possible one in which the mother and baby can 
be kept clean, sweet and comfortable. The mother's 
and baby's wardrobe should be laid away in separate 
convenient places where they will be accessible to 

54 



both doctor and nurse. Bureau drawers are preferred 
which have been cleaned and prepared for this pur- 
pose. If you cannot have the clothing as you would 
like, do the best you can under the circumstances. 

Selection Of The Room. — -The choice of the lying-in 
chamber is a matter of great importance. If to the 
nurse is left the selection, choose one that is large.. 
well ventilated and as far removed from the toilet 
and bathrom as possible ; one that can be kept at a 
uniform temperature of sixty-eight to seventy degrees 
Fahrenheit, and if possible, one that has the southern 
exposure. The sunlight is a very important agent in 
the sick room and should always be introduced when 
possible. An open fire place is a very desirable 
feature, as it serves a double purpose, heating and 
ventilating at the same time. Under no circumstances 
can a room be used which has been occupied by a 
patient suffering with a contagious disease or sup- 
purating wound, such as diptheria, scarlet fever, 
erysipelas or cancer ; nor any of the furniture used 
by such a patient be admitted into the lying-in room. 
If, however, the bed chamber is used as the lying-in 
room, and this is generally the customary rule, the 
unnecassary draperies, ornaments and all superfluous 
furniture should be removed and the room thoroughly 
cleaned. The walls brushed down so as to remove 
any particles of dust, the room well swept, and the 
furniture wiped with a damp cloth. During the day. 
if the room is not in use, the windows should be left 
open so it may be thoroughly aired and ventilated 
especially if used as a sleeping apartment during the 
night. In case an infectious disease has occurred in 
the house, have the house thoroughly disenfected. If 
you are with your patient see that these instructions 

55 



are carried out. If not expected until labor is im- 
minent, leave instructions with the expectant mother 
and put stress on their being carried out one week 
before expected confinement. This will insure more 
safety for your patient, the cleanlinness of the room 
and its contents. Freedom as far as possible from 
germs and dust are of vital importance. The removal 
of unnecessary furniture will render it more con- 
venient for the doctor during labor and delivery, as 
it alllows him more freedom. The room, however, 
should not be made to appear bare or cheerless, and 
particular attention should be paid to artificial light. 
The best obtainable should be procured, and a drop 
light is best for this purpose. Where a coal oil lamp 
must be used, it should be in good condition and have 
a reflector. 

STERILIZATION. 

Labor Pads. — Labor pads, vulva pads, operating 
gowns and towels may be sterilized by putting them 
up in separate packages, wrapped in a sheet and 
securely pinned and steamed one hour. They are 
dried by placing them in the oven and baking them. 
Open only when needed. This is. however, not a very 
satisfactory method. They are hard to dry thorough- 
ly and should be used almost immediately as they 
will milldew if not perfectly and thoroughly dried 
It is best to get ready all things necessary, wrap 
each class of articles in a separate package, labeling 
each, then wrap all the packages together in a sheet 
making one large package, and have them sterilized 
at some hospital. If this is impossible, make your 
OAAm dressings, using for this purpose sterilized cot- 
ton and gauze. In making your own dressings, first 
clean your hands as for a surgical dressing, then with 

56 



a pair of sterile scissors cut the gauze and cotton the 
size desired for the pads. These pads made in this 
manner are sterilized and surgically clean, and each 
pad can be made in this manner as needed. But we 
must use care to keep them surgically clean. Handle 
the gauze and cotton with clean hands and instru- 
ments. They must be surgically clean. Unroll the 
cotton and remove the cover from the jar before- 
cleaning and disenfecting the hands. Johnson & 
Johnson, also, put up two different maternity out- 
fits that are to be recommended, they are the "Simp- 
son's" and the "Cooke." These may be had through 
any drug store. 

INSTRUMENTS. 
Rubber sheets or oil cloths may be sterilized by 
washing off with a one to a thousand bichloride of 
mercury solution. Rubber syringes and douche bags 
may be sterilized by boiling twenty minutes in plaii^ 
water. Hand brushes are sterilized by boiling 
twenty minutes in plain water. All instruments are 
sterilized by boiling twenty minutes in a four per 
cent of bicarbonate of soda solution. The instru- 
ments should be wrapped in a towel before placing 
them on to boil and kept wrapped until needed. The 
needles should be run through a piece of gauze or 
cloth, and then rolled up, and should remain so un- 
til needed. 

Bed pans are sterilized by boiling twenty minutes 
in a wash boiler or washing them thoroughly in a 
one to one-thousand bichloride solution. 

The basins should be filled two thirds full of 
water, place one basin over the other, covering in 
the steam, place them on the stove and boil twenty 
minutes. 

57 



When sterilization of the sheets or labor pads is 
impossible, boil one dozen towels in a one to a 
thousands bichloride solution twenty minutes, and 
with surgically clean hands, according to directions 
given below, wring the towels out as needed and place 
them immediately under the buttocks of the patient 
over the pad. Remove the towels when soiled 
and replace with a fresh one. This insures safety for 
your patient and renders the sterilization of the sheets 
unnecessary. Allow the towels to remain folded 
when placing them on to boil and only unfold as each 
is used. For vulva pads for the first hve days use 
first a thin pad of absorbent cotton boiled in a one 
to live thousand bichloride of mercury solution, or a 
one per cent of lysol solution. Have the pad large 
enough to entirelv cover the birth canal and hairy re- 
gion so as to prevent any germs entering the genitals. 
Over this a large pad of dry sterilized absorbent cot- 
ton, or use absorbent cotton wrapped in sterile 
gauze. 

Sterilization Of The Hands. — Scrupulously clear) 
the hands. Scrub the hands and forearms Avell with 
a soft brush, soap and water, paying special attention 
to the linger nails, which should be cut short, and 
between the fingers, then wash off with plain sterile 
water. Afterwards immerge them for several minutes 
in a solution of bichloride of mercury in the strength 
of one in two thousand. Use all precaution to pre- 
vent puerperal sepsis. 

OTHER DIRECTIONS. 

Other directions than these must come from the 
phvsician in charge of the case. 



58 



CHAPTER VII. 

Labor. — Under the term labor includes the physi- 
ological and mechanical process by means of which 
the removal of the child and its appendages from the 
body of the mother takes place. The expulsion of the 
fetus from the uterus either spontaneously or by 
artificial means. At the end of nine months the fetus 
is fully developed, and is expelled from the uterine 
cavity. This process is known as labor. The pro- 
cess should be gradual for the safety of both mother 
and child. Rapid labor is attended with danger tc 
both. For convenience it is divided into three stages 
In natural labor the child is expelled spontaneously 
by the contraction of the uterine and abdominal 
muscles. After the rupture of the amniotic sack the 
uterus contracts down directly on the child, forcing 
and propelling it along the pelvic canal. In mechani- 
cal or artificial labor the child is removed from the* 
mother by the use of forceps or other surgical pro- 
cedure. If such expulsion occurs before the seventh 
month it is known as abortion or miscarriage : be- 
tween the seventh and ninth months, premature 
birth. About two weeks before delivery symptoms 
of approaching labor manifest themselves. They are 
false pains, lightening, or the sinking of the fetus 
head in the pelvic canal, frequent urinations and dif- 
ficult locomotion. If you are engaged so as to be 

59 



with your patient several days before expectant labor 
commences, you should have everything in readiness 
so there will be no delay or excitement at the all 
important time. It is during the first stage of labor 
that the nurse is often summoned, and she should 
answer the call as promptly as possible so as to have 
time to make all necessary preparations for the birth 
of the child without hurry. 

The obstetrical bag of the nurse should contain : 

Clinical thermometer. 

Bath thermometer. 

Chloroform mask. 

Medicine dropper. 

Graduate medicine glass. 

Glass and rubber catheters. 

Combination hot water bag and fountain syringe. 
This is to economize space. 

A two ounce 
bottle of fluid 
extract of er- 



A four ounce 
bottle of chlo- 
roform. 

Rectal and 
douche n o z- 
zels. 
A sdass douche 




Fig-. 16 — Combination hot water bag- and foun- 
tain syringe. 



nozzel, some physicians prefer them. 

A pair of blunt-pointed scissors, for cutting the cord. 
Two pair of artery forceps. 



60 



A bottle of bichloride of mercury tablets, large size, 

for making solution. 

Two hand brushes, with plain wooden backs that 

can be boiled. 

Xarrow linen bobkin tape for tying the cord. 

Hypodermic syringe. 

Hypodermic tablets of ergotin, strychnine, glonoin, 

digataline and ergotole. 

Small package of sterilized cotton. 

Small package, about two yards of sterilized gauze. 

Six ounces of green soap. 

Boric acid, two ounces. 

Aromatic spirts of ammonia, two ounces. 

Brandy two ounces. 

Collodian, two ounces. 

Nitrate of silver, one ounce, in strength 

of Gr. V to one ounce of water. 

Alcohol, two ounces. 

A glass graduate, holding about four or 

five ounces for measuring the urine after 

confinement. 

One probe. 

One pair uterine forceps. 

A small pitcher or granite cup, holding 

about a pint, to use in irrigating. 

A pair of infant's scales, a nice little pair 

about four inches long can now be had at 

most surgical supply houses, costing about 
fant's scales. 

fifty cents. 

A little hammock, made of soft outing cloth to 

61 



weigh baby in. See description and illustration of 
the hammock. 





Fig-. 18 — Pattern of baby's ham- 
mock showing- the different parts of 
same. 



A pair of rubber gloves 
A nice little steri- 
lizer, the length of a 
pair of delivery for- 
ceps, and about the 
width of an ordinary 
shoe box, can now 
be had at most surg- 
gical supply houses, 
they are made of 
copper and are so 



Fig. 19 — Baby's hammock 
complete. 







Fig. 20 — A nice small sterilizer 
that can be conveniently carried. 
Cost $5.25. 



convenient, saving much time in trying to find some- 
thing suitable to boil the doctor's instruments in. All 
of the other necessities can be packed nicely in the 
sterilizer and thus it does not take up much space. I 
have found it very convenient. 

A pair of reins, see description of them elsewhere. 

A pair of leggins, made of soft outing cloth to be 
worn during labor. 



62 




Fig-. 21 — Obstetrical leggings showing outer and inner side. They 
are tied with tape back and in front to keep them from slipping 
down. 




Fig. 22 — Nurse's or doctor's obstetrical gown. 

63 



Three dozen safety pins, two dozen large, one 
dozen medium. 

Two obstretical gowns, two in case one should be- 
come very soiled, or in case the doctor may need a 
second one. 

A nail file. 

One soft outing flannel apron to be worn while 
bathing the baby. 

Two full uniforms. 

A supply of record sheets or bedside records for 
mother and child. 

Three aprons. 

Six pair of cuffs, if colored uniforms are worn. 

One cap ready to put on. 

One suit of underclothes. 

Two pair of stockings. 

Two nightgowns. 

A supply of handkerchiefs, collars and dress shields. 

A package of sanitary napkins. 

A kimona or wrapper of light material and a pair 
of bedroom slippers. 

Comb, brush, washcloth, soap, towels, toothbrush 
and powder. 

It may seem unnecessary and foolish to attempt 
such a supply. I have never found it so. Often I 
have been glad I was so equipped, especially for coun- 
try practice. It is best to go prepared for emergencies 
even if we never encounter them. Often life depends 
upon us being well supplied. Of course, if you are 
engaged for the case, and your patient has been fur- 
nished with a list of what she should have in readi- 
ness, it will not be necessary to furnish or carry in 
your dress suit case the articles mentioned in the fore- 
going list that the mother may require for her use. 

64 



The list is furnished for emergency cases and country 
practice. The list of articles mentioned for a nurse's 
wardrobe is not sufficient for an out of town case, the 
nurse must judge for herself just what and the num- 
ber of each article needed. It is, also, well for the 
nurse to have an inventory pinned in the front of 
her suit case, and place the articles in her satchel in 
order as they are on the inventory list, in this way 
she is certain of leaving nothing out that may be 
needed. Answer an obstetrical call promptly so there 
will be plenty of time to have everything in readiness 
for the doctor's arrival without hurry or confusion. 

Recognition of Labor. — Certain symptoms proceed 
the outset of labor, beginning ten days or two weeks 
previous to it when the fetus descends somewhat in 
the pelvic cavity. At the expiration of two hundred 
and eighty days, the average woman experiences a 
different kind of a pain in the back. They stay a min- 
ute or two and then cease. They occur two or three 
hours apart. Contractions of the uterus takes place, 
and the uterus and abdomen gets very hard and 
tense. As labor approaches the pains become more 
and more severe and the neck of the womb gets 
larger. If you would make an examination, you will 
notice as the cervix, stretches the neck of the womb 
gets thinner and thinner until it disappears and only 
a thin ring remains. As soon as the nurse arrives at 
the house of the patient, she should ascertain if labor 
has really commenced. That is, of course, if the phy- 
sician has not been summoned. Sometimes a patient 
is deceived by false pains, and the sudden emptying of 
a full bladder involuntary is sometimes mistaken for 
the amniotic fluid. The accurate recognition of labor 
is a very important thing for a nurse to know. To 



[5] 



65 



ascertain if a patient is in labor or not, place her on 
her back on the bed. Place your hand on the ab- 
domen. If labor has commenced the uterus can be 
felt to contract and relax at almost regular intervals. 
If labor has not commenced the contractions will not 
be very pronounced, and if the amniotic sack has 
ruptured the uterus will assume more the shape of 
the child, and lose its globular form. The nurse can 
tell prett)' T well of the progress of labor by the regular- 
ity and severity of the Uterine contractions, and as 
soon as she is certain from the character of the pains 
that labor has commenced she should notify the phy- 
sician in charge of the case. He may not respond at 
once, but it is only just and proper he should know 
his patient is in labor so he can arrange his time and 
engagements accordingly, and be ready to come, and 
the nurse know where to find him when needed. In 
notifying the physician the nurse should tell him how 
long labor has been going on, how severe the pains 
are, and how often they occur. As soon as the phy- 
sician has been notified, the nurse should begin to 
arrange the room for labor which should be clean 
and warm, and ample preparations for delivery and 
after care should be made with strict attention to 
aseptic details. If labor occurs at night, ample pro- 
vision for lighting should be made. The best artificial 
light obtainable should be procured. A drop light is 

beSt * FALSE AND TRUE LABOR PAINS. 

True Labor Pains. — The symptom of labor which 
is noticeable to the patient are pains in the lower por- 
tion of the body. Expulsive uterine contractions. 
True pains usually begin in the back, and occur with 
a regularity almost perfect. In the first stage of labor 
this pain begins in the back and extends gradually 

66 



around the body to the pelvic region. These pains 
are at first faint but annoying, but they became more 
and more severe as labor proceeds. 

False Pains. — False pains occur at irregular inter- 
vals. They are chiefly confined to the lower front and/ 
sides of the abdomen, never extending around to the 
back, they are short and ineffective, and are never 
accompanied by any actual bearing down sensation. 
They are very often caused by constipation. A saline 
enema will usually give relief. 

THE DIFFERENT STAGES OF LABOR. 

First Stage. — The first stage of labor is the dilation 
of the cervix. This is a gradual process. It begins 
with the first pain and lasts until the full dilation of 
the os. As the os internum opens, the contractions 




Fig-. 23— Child in the uterus at the beginning- of labor. 

causes the membranes to descend and press upon the 
cervical canal. The effects of the uterine contractions 
is felt directly on the amniotic sack or bag of water 
in which the child is enclosed. The cervix being the 

67 



point of least resistance, when the uterus contracts 
it forces the amniotic sack in the direction of the os, 
from within outward. This bag of water has very 
important functions. First it dilates the cervix and 
vagina evenly and safely ; secondly, it protects the 
baby from injurious pressure on any one part, because 
when the uterus contracts, the force exerted presses 
equally in all directions, and after rupture it lubri- 
cates the downward passag-e, making the child descend 
with less effort, and lastly it flushes the vagina, and 
in case there is infection present, it washes it out. 
preventing it getting' into baby's eyes. With the 
advance of labor the pains increase in intensity and 
frequency. Each succeeding pain increases the dila- 
tation. In true labor the dilatation progresses gradu- 
ally. An examination at this period we could easily 
define the orific of the uterus ; the border of the os or 
ridge slit lip like opening of the uterus. This ridge 
becomes well marked. At first it simply separates ; a 
slit-like opening; gradually it assumes a circular 
shape. Labor then progresses more rapidly. With each 
new pain the amniotic sack is pressed down which pro- 
duces a gradual and even dilatation which continues 
until the tissues are fully relaxed. During this pro- 
cess the cervix is often slightly lacerated, and the 
mucus discharge becomes tinged with blood. This 
is called the "show." If there is much pure blood with 
the show, it is abnormal and the physician should be 
informed of the fact. The show may occur both be- 
fore or after the rupture of the amniotic sack. Some- 
times it is the first warning a patient has of approach- 
ing labor, the sack does not rupture until a few hours 
before delivery. Then again the sudden rupturing 

68 



of the amniotic sack is the first warning to the patient, 
the show does not appear until afterwards. The 
bursting of the amniotic sack often occurs suddenly, 
and a quantity of water, varying from a few ounces 

to several pints escape. Young patients, sometimes. 
become very much frightened when this occurs for 
want of knowledge of what is taking place. So it 
would be wise for the nurse who has a patient preg- 
nant for the first time to explain this condition to her. 
I know of two cases where the patient looked for- 
ward with terror to her approaching delivery, and af- 
ter thev were well and up again told me how they 
suffered and how frightened they were because of 
ignorance. They thought an incision was made in 
the abdomen and the child extracted in that manner. 
This only illustrates to us how often a patient must 
suffer for want of knowledge that a little thought on 
the part of the nurse may save them. The length of 
this stage varies a great deal from three to ten hours 
(Professional experiences). During this stage there 
is nothing the physician can do. and the nurse employs 
the time in getting ready for the birth of the child. 
The bursting of the water or the rupture of the 
amniotic sack usually marks the end of the first and 
the beginning of the second stage of labor. When 
the os is sufficiently dilated the bag usually ruptures 
and the amniotic fluid escapes. After this the head 
descends into the vagina. 

The Toilet of the Patient for Labor. — As soon as 
labor begins give the patient a warm soap suds enema 
followed by a warm pitcher bath. This is accomp- 
lished by the patient standing in the bath tub. The 
body is Avell drenched with warm water. To accomp- 
lish this use either a hand spray or pitcher. Then 

69 



with a bath brush or crash mitten or cloth and green 
soap all portions of the body are briskly lathered. 
Particular care is given the area between the ensiform 
cartilage and the knees. The patient then stands un- 
der the shower again and all lather is thoroughly re- 
moved with friction. Either hand spray or pitcher 
being used. The tub bath is not considered so sterile 
a procedure as this one, in fact it is now considered 
a means of infection. The particles washed off of the 
skin into the water, and the patient sitting in a tub 
of dirty water it is possible for infection to enter the 
vagina and cause trouble. If circumstances will not 
permit the pitcher bath, give a general sponge bath. 
If it is an emergency case, and there is no time for 
even a general sponge bath the lower abdomen, but- 
tocks and genital organs MUST be thoroughly cleaned 
and disinfected. It may, also, be necessary to use 
the catheter, owing to the closure of the urethra by 
pressure of the presenting part. This is, however, 
not a frequent occurence, and when it is necessary the 
physician should always be consulted, and great care 
must be exercised not only to have everything sur- 
gically clean, but that the secretions of the vagina 
do not come in contact with the Catheter or you may 
have serious trouble. The catheter is seldom used, 
the patient generally voids urine involutarily. Never 
give a vaginal douche unless directed to do so by the 
physician in charge of the case, and the nurse should 
never make a vaginal examination unless told to do 
so by the attending physician, and before making a 
vaginal examination the nurse's hands should be 
cleaned as for a surgical operation, according to di- 
rections that have been already given or sterile rubber 
gloves worn. The vulva should, also, be cleaned as 

70 



a field of operation, as the danger of carrying infection 
is great. After her bath the patient should have a 
clean night gown on. Her hair should be combed 
and braided in two braids. Then have your patient 
lie on her back in bed, place the douche pan under 
her, and scrub the lower abdomen, thighs, buttocks, 
perineum and genitals with green soap and a soft 
brush or gauze, and particular attention should be 
given to the removal of any smegma from the clitoris. 
The hair around the vaginal opening should be cut 
close to the skin, or better still, if the patient does 
not object too strongly, the vulva shaved. Then in 
case of a tear in the perineum there is no delay in 
repairs, it is easier to keep clean, and less danger of 
infection in case there are stitches. Care must be 
taken that no wash water or other solutions runs 
into the vagina, and in washing the anal region a 
cloth or cotton pleget that has passed over the anus 
must not be used around the vulva orifice, but should 
be thrown away, and a clean one used. The douche 
pan should now be removed and emptied and re- 
placed under your patient and she should 
remain on it while the nurse cleans her 
hands, according to directions already given. The 
cleaning of the hands requires about five minutes. 
After washing and disinfecting the hands throw the 
covers off of your patient with the elbow so as to 
avoid soiling them. The covers should have been 
previously arranged so this may be done. Now wash 
the patient's genitals, lower abdomen, perineum and 
thighs in a one to two thousands bichloride of mercury 
solution, using absorbent cotton. After cleaning all 
parts antisepticly, the vulva pad is applied. It is 
made of dry sterilized cotton held in place by a T- 

71 



bandage of gauze or cotton. It is to protect the parts 
and absorb any discharge that may escape from the 
vagina. A pad once removed must never be replaced, 
no matter if it is perfectly clean. And the patient 
should be warned not to touch the parts or sit on the 
water closet after this preparation. Wipe the other 
parts dry with a clean towel. The patient may now 
be dressed in her night gown, stockings and slippers 
and a bath robe or kimona or wrapper of light ma- 
terial and allowed to sit up or walk around the room 
until the pains become severe enough to confine her 
to her bed, or until the rupture of the amniotic sack. 
It is best to encourage the patient to walk around un- 
til the amniotic sack ruptures as it favors the descent 
of the child's head in the pelvis and thus assists nature 
in rupturing the sack. If the pains are severe and 
change from the back to the front, the patient should 
be put to bed before the membranes rupture, if the 
event can be anticipated. As the body in the upright 
position when this occurs there is more danger that 
the umbilicus cord will be washed down in the gush 
of water. 

Second Stage. — The second stage of labor is the ex- 
pulsion. Beginning with the full dilation of the os 
and ending with the expulsion of the child. During 
this stage the pains become more severe, and uterine 
contractions are stronger. After the rupture of the 
amniotic sack the cervix usually contracts but 
yields readily to pressure and offers no resistance to 
the presenting part. For these reasons a patient should 
not leave her bed from the time labor reaches the 
second stage, which is generally after the rupture of 
the amniotic sack, and the pains become severe and 
change from the back to the front. Each pain in- 

72 



creases the dilatation of the internal os. As labor 
advances the pains increase in intensity and frequency. 
In the beginning of labor the pains are about an hour 
apart, the intervals decreasing gradually. After the 
amniotic fluid escapes the uterus contracts down on 
the child direct, and the patient experiences a desire 



rt---'.""^- z 

% 


% #Jt% 


V: 


Si f ' \ V\ 


&&■ 






^S^-^^sw 


§W\ 






*^<[_s? % 







Fig. 24 — Diagram showing- the advancement of the head through 
pelvis. (Lushman.) 

to strain and bear down. The pains continue until 
the cervix dilates, and the child descends into the 
pelvic cavity and is expelled. The first pains are de- 
scribed as grinding ; later as cutting and bearing 
down; this is when the child descends in the pelvis. 
Pains at the expulsion of the fetus is described os 
tearing. After the rupture of the amniotic sack, 
which usually occurs spontaneously late in the lirst 
stage of labor, the water in front of the child's head 
escapes, although a greater part of the amniotic fluid 
is retained within the uterus by the presenting- part. 
This fluid lubricates the downward passage of the 
child, making labor less tedious, as it enables the child 
to descend with less effect. After a time the head 

73 



descends into the cervix. This is the slow part of 
labor when the head comes down in the pelvis. The 
pains are now bearing down, tearing and hard. In 
case the membrane have not ruptured and the fetus 
descends to the vulva, it should be gently ruptured 
with finger-nail. But never should this membrane 
be ruptured until the presenting part is visible at the 
vulva. If ruptured while the child is in the cervix, 
the dilating factor is removed and labor is slow and 
tedious. In some cases the rupture occurs near the 
child's neck and the head is born covered with so- 
called "caul" or veil, which is considered by some old 
ladies as a lucky omen, which are only particles of de- 
tached membrane. There are cases where the child 
has been delivered without even this sack being rup- 
tured. In rare cases where the fetus is small, and the 
amniotic fluid is limited, the entire ovum may be ex- 
pelled without rupturing of its coverings. Such a case 
is termed dry delivery. In such a case rupture the 
sack and take the child out immediately ; if it should 
breathe it would drown. Remember to use only the 
finger-nail in rupturing the sack. Any pointed in- 
strument might injure the child. In some cases the 
rupture of the membranes take place twenty-four to 
thirty-six hours before the birth of the child. Then 
we have what is termed dry labor. This is very un- 
desirable, the labor is slow, tedious and painful. In 
such a case the patient should be kept in bed on her 
back and a pillow placed under the hips to elevate 
them to prevent further escape of the little fluid that 
may still remain in the uterus. Sometimes a full blad- 
der emptied suddenly is mistaken by the patient for 
the amniotic fluid. To distinguish between the two, 
if the sack has ruptured the watery discharge will con- 

74 



tain small particles of cheesy substance, vernix 
casesa, which is the same substance that is found on 
the body of a new-born infant. If urine, it will be 
clear, no particles present. The lying-in patient 
should be clothed only in her night-gown. This, dur- 
ing labor, should be folded up neatly under the arms 
out of the way, and pinned with a safety pin. Better 
still, a short sacque night-gown be worn during labor. 
Long leggins made of light weight flannel should 
cover the lower extremities and a sheet pinned around 
the waist in skirt fashion which can be lifted or thrown 
back when the doctor wants to make an examination. 
The patient should not be permitted, as a rule, to 
leave her bed after the rupture of the amniotic sack 
and the pains become severe, not even for the evacua- 
tion of the bladder or bowels, and under no circum- 
stances should the water closet be used by a patient 
after the commencement of labor. After the patient's 
toilet a sterile slop jar or chamber is used in the con- 
finement room, and a sterile bed pan is used in the 
confinement bed. When a patient gets so far ad- 
vanced in labor that she remains in bed a bichloride 
pad, a large piece of sterilized absorbent cotton, 
wrung out of a one in two thousand bichloride of mer- 
cury solution is used to cover the genitals. This pad 
should be large enough to entirely cover and protect 
the birth canal. It is held in place by a T bandage, 
and should be kept on until the head of the child is 
visible at the vulva. When it is necessary to change 
the pad, which must be done as often as it becomes 
soiled, the hands of the nurse should be prepared and 
disinfected as for a surgical dressing. After the rup- 
ture of the membranes the pains become stronger and 
more frequent. With each new pain the child makes' 

75 



preceptible progress, retreating, however, when the 
pain declines. There is no use for the mother to bear 
down until the head is in the pelvis, it simply exhausts 
her strength ; the vagina must first be distended, the 
head then descends. It slips back, slips down and 
back again. This is natures prevention against a 
tear. If it descended in haste and rushed through, it 
would tear the perineum. The head rotates, and as it 
were, feels its way. "When the pains become severe, 
firm pressure against the back during a pain usually 
gives relief. At this stage the patient should never 
be left alone, and the nurse should use every means 
to comfort and reassure her patient. At this period 
the pains are severe and regular, followed by short 
periods of absolute rest and quiet. The patient usu- 
ally falls into a light slumber which is nature's pro- 
tection against exhaustion. When the pains occur as 
often as every ten minutes the physician should be 
sent for, of course the distance he has to come must 
be considered, and if it is great and in second and 
later labors send sooner. But this degree of frequency 
is an indication that the second stage of labor has 
reached the period when the presence of the physician 
is desired. The pains are now bearing down, tearing 
and hard. 

The attempt of nature to expell the uterine con- 
tents. The patient may now be allowed to pull upon 
a sheet fixed to the foot of the bed or the hands of the 
nurse. A good thing I use and always carry with 
me on an obstetrical case are "reins.'' Below is a de- 
scription of these "reins." Try them and you will 
be pleased with the results. They are so much su- 
perior to a sheet. It should not be used or the patient 
allowed to use a tractor after the head reaches the 

76 



perineum. As the birth of the head should be rather 
restrained than hastened to avoid a perineum tear. 
When a true pain occurs instruct your patient to 
take a deep inspiration, hold her breath and bear down 
as if encouraging an evacuation of the bowels. The 
feet should rest with the soles flat on the bed, the 
reins are adjusted the proper length by tying firmly 
to the foot of the bed or springs, and the upper ex- 
tremities, by the use of the reins, rinding secure fix- 
ation, the effect is twofold, the patient suffers much 
less, reaps the full benefit of her pain and labor is 
thus shortened. The average duration of a labor pain 
is one minute. The average length of the second 
stage of labor is about three hours. The uterine wall 
is muscular tissue, and each pain at birth means a 
contraction. 

Preparation for the Bed. — "While the patient has 
the freedom of her room during' the first stage of labor, 
the nurse should prepare the bed. Cover the mattress, 
which should be a flat hair mattress. Avoid feather 
beds. The mattress need not necessary be made of 
hair, but should be a good, comfortable, firm mat- 
tress. Cover the mattress with a sheet. Always allow- 
ing plenty of sheet to be tucked under the mattress at 
the top, as it will have a tendency to slip downward. 
and fasten it at the corners with safety pins. Over 
this clean sheet place a rubber sheet or piece of white 
enamel oil cloth, which should be firmly pinned to the 
mattress. Cover the rubber sheet with another clean 
sheet, and over this is placed the labor pad. Some 
physicians use a Kelly pad. Place the pad on the 
right side of the bed, midway betweeen the head and 
the foot of the bed, so that the patient's buttocks will 
rest on the center of the pad, and it should be well 

77 



over the edge of the bed so as to protect the mattress 
on the side. All linen and bed clothes used on the 
parturient woman's bed should be freshly laundered. 
The bed should be placed so as to get the best light 
possible. 

A Good Labor Pad. — A good labor pad is made as 
follows : Take a clean sheet, if you can obtain an old 
one that can be burned afterwards, the better. Fold 
it four times, that is, lengthwise and then crosswise, 
making a square. Spread it out on the table, take 
newspapers, lay them lengthwise and crosswise, 
so as to hold the pad together. That is, unfold them 
their full length, place two, thus unfolded, side by 
side, lengthwise. Then lay one lengthwise across the 
bottom of the two thus lying lengthwise, over- 
lapping them about two inches, this makes the 
pad complete and holds them firmly in position. Con- 
tinue so until they are about two inches thick, then 
turn over the edge of the sheet several inches, and tack 
it or pin it with safety pins. Sewing is preferable to 
pinning, and if you find the paper seems to slip, tack it 
here and there to hold it in position. If pins are used, 
pin as often as it is necessary to hold it in place. This 
pad is large enough to receive all discharges on the 
birth of the child, and at the conclusion of labor it 
can be removed and burned, leaving the bed nice and 
clean. 

Directions for Making the Reins. — They are made 
of bleached muslin. Take three and a half yards of 
heavy bleached muslin, about the same quality and 
weight as sheeting, about one yard wide ; tear it 
through the middle. Now sew the ends together on a 
sewing machine. This makes a length of seven yards. 
Now fold this through the middle, lengthwise, four 

78 



times ; turn in the raw edges and sew firmly all 
around. It is best to sew the edges twice around 
on a sewing machine. This makes a pair of reins sev- 
en yards long, six or seven inches wide and four thick- 
nesses, and it is quite an improvement on either the 
sheet or the hands of the nurse, as the patient can, 
when they are adjusted to the proper length, by 
tieing them to the foot of the bed or springs, pull on 
them evenly and get the full benefit of the pain, and 
the nurse is seldom called upon to loan herself, or 
strength, as a tractor. Try them and you will be 
pleased with the results. 

Preparation for the Doctor. — Having prepared the 
bed for your patient, the next thing to do is to see 
that everything is in readiness for the doctor. On a 
table at the right side of the bed the following articles 
should be arranged in completeness. 

Fluid extract of ergot, and a graduate glass or tea- 
spoon to use to measure or administer it in, in case 
of hemorrhage. 

Chloroform and mask, ready when needed. 

A bottle of bichloride of mercury tablets, (large 
size), for making solutions. 

A sterile douche bag and nozzle, ready if the doc- 
tor should ask for it after the delivery of the placenta. 

A bottle of liquid soap or six ounces of green soap. 

A hypodermic syringe in completeness, with tab- 
lets of strychnine, ergotin, glonoin, digitaline and a 
vial of ergotole, and a small bottle of sterile water 
for making the solutions. 

One pint of sterile vinegar, to use if necessary to 
secure the contraction of the uterus. 

Three sterile granite basins, large size is best. 

Three sterile hand brushes. 

79 



A tube of white vaseline to lubricate the hands. 

Small box of boric acid powder. 

A cup of saturated solution of boric acid, for ba- 
by's eyes and mouth. 

A cup or saucer with small plegets or little cotton 
balls for wiping baby's eyes, immediately after the 
the head is born. 

A one-ounce bottle of nitrate of silver solution, 
grains Y to one ounce of water, also a clean medi- 
cine dropper to use in dropping the solution if the 
physician thinks it necessary to use for baby's eyes. 

A bottle of olive oil, to anoint the baby immediate- 
ly after birth. 

Six dozen safety pins, four dozen large, two dozen 
medium size. 

Sterile linen bobkin tape for tying the cord. 

Two pair of sterile artery forceps to use in an 
emergency, they can be clamped on the cord if an 
emergencv arises, the cord is severed, and tied later on. 

One pair of sterilized, blunt-pointed scissors, for 
cutting the cord. 

One pound of good, sterilized, absorbent cotton. 

One dozen towels, boiled in a one to two thousand 
bichloride of mercury solution to place immeditely 
under the buttocks of the patient over the labor pad. 
When towels cannot be had, the infant's napkins 
mav be sterilized and used for this purpose. 

An abdominal binder, for the mother's use. 

A nail file, for the doctor's use. 

An obstetrical gown, for the doctor to wear during 
labor and deliver}". 

A clean slop jar or bucket should be placed in a 
convenient place to receive the waste and water. 

A clean vessel to receive the placenta; a clean 

80 



chamber with a lid is best for this purpose. Place 
it under the right side of the bed, and it can be had 
without trouble when needed. 

A small foot tub to receive soiled cotton and linens. 

Have plenty of hot and cold water so solutions 
can be made immediately upon the arrival of the doc- 
tor. Never keep him waiting. There should, also, be 
ice in a convenient place, so it can be had immediate- 
ly should the doctor need it. 

Preparation for the Reception of the Baby. — 
In a convenient place, the baby's cradle or bed 
should be placed the woolen blanket that is to re- 
ceive the child. A napkin is folded and placed in the 
blanket in such a way that when the baby is placed 
in the blanket, it can be placed on the napkin ; the 
ends drawn up between the legs, as you would ar- 
range a napkin to put on a baby, so in case the in- 
fant's bowels move, it and the blanket would be pro- 
tected. It is to protect the blanket as well as for ba- 
by's comfort. If the child's bowels move and this 
precaution is not taken, the infant's body becomes 
smeared and soiled, also the blanket. The meconi- 
um is difficult to wash out and often leaves a perma- 
nent stain in flannel. A nurse ought to be careful of 
these little details, they mean so much. One of the 
squares of old clean cloths is put in the napkin, so as 
not to soil or stain it either. The hot water bag is 
then placed in it to 
keep it warm until 
the little stranger 
arrives. These are 
the duties of the 
nurse during the 
first stage of labor, 
and she should have 

all in readiness SO Fig. 25— Blanket with hot water bot- 

G1 tie awaiting- the arrival of the little 
[o] o± stranger. 




there will be no delay or confusion at the time her 
services will be needed by the physician. After all 
is done in preparation devote your whole attention 
to your patient. Do everything possible for her com- 
fort. Give her sympathy and encouragement. 

The Position of the Child. — While the nurse should 
never make a vaginal examination without orders 
from the attending physician, as soon as she reaches 
the home of the patient she should make an ex 
ternal examination of the abdomen and try and 
outline the position of the child, so as to have 
an idea of the position and presentation in case 
the physician does not arrive in time. It 
is often desireable that the nurse be able to tell if 
the presentation is normal, especially is this true in 
country practice. To make an external examination. 
place your patient on her back on the bed. Ask her 
to take a deep inspiration, and when she exhales, by 
pressure, placing both hands on the side of the ab- 
domen, the nurse brings the the large uterus between 
them, and the outlines of the child can be plainly dis- 
cerned. If the greatest diameter lies paralelled with 
the mother, the same direction, the fetus in lon- 
gitudinal, and if the child is longitudinal, the child lies 
either head or breech presentation. To make sure 
which part presents, the nurse places her hands on 
the lower abdomen and presses with her finger tips 
until she fells the lower extremity of the fetus. If it 
is round and hard, it is the head; if it is 
soft and uneven in shape, it is the breech. 
And by placing both hands on the sides of 
the abdomen and pushing inward, alternately, the 
nurse can determine the child's back, which is the 
most resistive side. The head is recognized by its 

82 



hardness and rounded form ; the back is soft and 
even ; while the breech is of an uneven shape, small- 
er in size and softer in consistence. The feet are ex- 
tended so as to come in contact with the legs and are 
situated upon the abdominal sides of the child and 
iike the forearms, they are often crossed. The arms 
are crossed upon the chest. The child in the uterus 





Fig. 26 — Side view of the fetus. Fig. 27 — Front view of the 

showing the attitude it holds in fetus, showing the attitude it 
the uterus. holds in the uterus. 

is folded together. The legs are bent on the thighs, 
the thighs are flexed on the abdomen, the forearm on 
the arms, the arms across the chest, and the head 
bent down over the breast. 

It is easy to distinguish between the amniotic fluid 
and the child. The fluid is soft under pressure, and 
even presenting no distinct parts. After the rupture 
of the amniotic sack, the child gradually descends in 
the pelvis. In natural labor the head presents ; it being 
the heaviest portion of a body floating in water. The 
first position is the occiput to the left and in front. 
If this position is maintained during labor, the larg- 



83 



est diameter of the child's head will correspond with 
the largest diameter of the mother's pelvis, and thus 
facilitates an easy delivery. The second position, the 
occiput to the right and in front. The largest diame- 
ter of the infant's head corresponding to a diameter 
of the pelvis, which is a little less than the first posi- 
tion, labor is. usually, a little longer. These are the 
normal and most common positions. There is, too. 
the breech, foot and arm presentations. These are 
usually longer deliveries and more dangerous to the 
life of the child. With these points a nurse can easi- 
ly construct the diagnosis. This examination should 
be made, however, before labor has commenced, as 
it is almost impossible to make it afterwards. Any 
manipulations after the commencement of labor will 
cause a contraction: The uterus becomes so tense it 
is impossible to feel the fetus and usually the mother 
is too nervous. So after the commencement of la- 
bor an external examination is almost impossible. 

The Duties of the Nurse After the Arrival of the 
Doctor. — After the arrival of the doctor, he will of 
course, take charge of the case and the nurse's duties 
consists, then in carrying out the doctor's orders and 
watching his and the patient's wants. Xo one should 
he allowed in the room of a lying-in patient, but the 
physician and his attendants. On the arrival of the 
physician he will want to make a vaginal examina- 
tion to ascertain the extent of the dilation, and the 
progress the patient has made. The nurse should 
have ready three sterile basins; one to use to scrub 
his hands in. with liquid or green soap, brush and 
water. Another with plain sterile water to rinse the 
soap Avell off his hands, and in the third basin a so- 
lution of bichloride of mercury in the strength of one 

84 



iii two thousand for disinfecting his hands as an anti- 
septic precaution. See that everything is ready : ba- 
sin, soap, brushes, water and the solutions. After all 
is ready for the doctor prepare the patient for ex- 
amination. Some physicians prefer the running water 
in bathroom for the cleansing of their hands ; in such 
cases it will only be necessary to prepare the solution. 




Patient prepared for doctor's external examination. 

The Preparation of the Patient for Examination. — 

For external examination the patient lies on the right 
side of the bed, close to the edge ; the sheet is folded 
back so that the edge just reaches to the pubes or 
lower extremity of the abdomen ; the night gown is 
folded neatly over the chest and covered by a towel, 
leaving only the abdomen exposed. The physician, 
by palpitating the uterus, determines the position of 
the child. 

For Internal Examination. — After the external ex- 
amination, and the physician determines the position 
of the fetus, he will want to make an internal ex- 
amination to ascertain the extent of dilation. 
The bed cloths are neatly folded over the foot- 
board of the bed. The patient lies on the right side 
of the bed with limbs drawn up and separated. A 
sheet is unfolded and thrown with its center over 

85 



the pubis, on the bias, the opposite corner is brought 
down so as to form a flap between the knees, 
the other corner covering, the same way, the 
upper part of the body. If leggins are worn it is not 




Fig-,29 — Patient prepared for doctor's internal examination. 

necessary to wrap the legs with the sheet ; if not 
worn the two other corners are drawn around each 
leg to cover them. The nurse, after cleaning and dis- 
infecting her hands as for a surgical dressing, re- 
moves the pad with a piece of sterile cotton or gauze, 
or a pair of sterile forceps. She then washes all dis- 
charge off with one to four thousand bichloride of 
mercury solution, or a one per cent lysol solution and 
applies a fresh pad. When the dctor is ready, .re- 
move the pad and arrange the bed clothes with as lit- 
tle exposure as possible. While the examination is 
being made, the flap of the sheet is dropped over the 
arm of the examiner. If the skirt sheet is worn it is 
used and adjusted in the same way. Have ready a 
tube of white vaseline to lubricate the hands of the 

86 



doctor. Be very careful in pouring it on his hands 
that it does not come in contact with any foreign ob- 
ject. Always wipe the edge of the bottle or tube off 
with a piece of cotton wet with a one to two thousand 
bichloride solution, and after wiping off the rim, pour 
a little out over the rim or edge before pouring it out 
over the doctor's hands. After the examination is 
made the parts are washed again with a bichloride of 
mercury solution and a sterile pad applied. All these 
precautions are taken to prevent infection. 

The Instruments. — All instruments required in each 
case are, of course, furnished by the physician, and on 
his arrival he hands to the nurse, whatever he thinks 
he will need in each case, for sterilization, which is 
boiled for twenty minutes in a four per cent bicar- 
bonate of soda. 

As labor proceeds the cervix retracts, and the head 
descends into the vagina, the part of the head first 
reaching the perineum rotates to the front and is 
brought under the pubic arch. Further descent of the 
head causes the perineum opening to be distended. 
Descent and extension or flexion, as the case may 
be, causes the head to pass out over the pubic 
arch into the vulva. The pains are now about 
a minute apart and are bearing down, tearing and 
and hard. The bones of the cranium are soft 
and yielding. They are united only by membranes 
so that when pressed together they can overlap. 
The lower part of the uterus is called the cer- 
vix; this part dilates and stretches, while the vagina 
and pelvis dilate and relax to allow the passage of the 
child. If the child be large and the tissues do not 
dilate readily, then lacerations may occur. The pa- 
tient may now be placed either on her back or left 

87 



side. Most accouchians in this country prefer the 
back. Should the abdomen become relaxed and the 
child recline too far to the side of the abdomen, the 
nurse should support it with her hands, especially 
during a pain. Some authorities advise the use of a 
bandage and tightened as labor advances. This sup- 
ports the wall of the abdomen and promotes expulsion 
with less effort. So, in the the absence of the phy- 
sician, the nurse must watch and guard against this 
condition, and support the abdomen with her hands 
during a pain if she notices this condition present so 
as to assist most effectually the work, and by keep- 
ing the child in the medium line, the abdominal con- 
tractions can exercise a greater influence in the ex- 
pulsion of the child, when a patient is delivered 
on her side, a pillow, protected by a rubber case, 
or several newspapers wrapped around the pil- 
low to protect it from being soiled by the dis- 
charges, over this a sterile cover or slip. If a 
sterile one cannot be procured, use one boiled in a 
one to three thousand bichloride of mercury solu- 
tion, or one of the towels that has been so prepared. 
The pillow is folded and placed between the pa- 
tients legs to separate them. Instruct your patient 
to bear down only during a true pain, otherwise she 
is apt to do so with every little pain she has and thus 
exhaust her strength. At this stage of labor a large 
pad of sterilized absorbent cotton, wrung out of a 
bichloride solution in the strength of one in three 
thousand, as hot as can be borne, is placed over the 
entire genitals, be sure it covers all parts. This is 
changed as often as it becomes cool. The applica- 
tion is very soothing and aids in the dilation of the 
vulva. It should be continued until the birth of the 
child. Here the clothing is generally thrown back ; 



the legs wrapped around with a sheet or long leg- 
gins are worn, the doctor watches the progress of 
labor, and it must be remembered that while the pa- 
tient must not be exposed more than is necessary, 
nothing- unsterilized must come in contact with the 
genitals; so sheets, unless sterilized must be thrown 
back so as to touch neither the patients genitals nor 
the surgeon's hands. The nurse should watch the 
rectum for any discharges. If the enema does not 
completely empty the bowels, as the child head de- 
scends it presses on the bowels and forces the con- 
tents out, and if the discharge gets into the vagina 
there is great danger of infection. The discharge 
from the anus should be received in a large pad of 
sterilized absorbent cotton or old, clean, sterilized 
linen, after which the vulva and perineum should 
be washed with cotton and a one to two thousand bi- 
chloride of mercury solution, wiping from the vulva 



Fig. 30 — Nurse curing cramps in leg during labor. 

towards the anus, using a fresh piece of linen or pad 
of sterilized cotton each time. 

Should cramps in the legs occur, straighten the 

89 



legs and pull the foot towards the knee and rub up- 
ward gently. This generally relieves this distressing 
condition. The nurse should see that fresh solutions 
for the doctor's hands are always ready ; that all 
soiled and bloody linens are removed and kept out of 
sight as much as possible. For this purpose the small 
foot tub is used. It should be placed as much as 
possible out of the way and sight so as to receive 
them. The pains becoming very severe, occurring 
every thirty seconds, the parts become greatly dis- 
tended. The head, which always presents in normal 
labor, becomes plainly visible at the vulva and during 
a pain bulges forth. The patient complains of a tear- 
ing sensation. It is at this stage that chloroform is 
generally given. There need be no fear of the result 
when it is used or its use is advised by a competent 
physician. As a rule chloroform is not given during 
the earlier stages of labor, because when given at too 
early a period it has a tendency to weaken the con- 
tractions of the uterus and thus retard labor. To ad- 
minister the chloroform for the attending physician 
usually falls to the duty of the nurse in normal cases, 
but she should have it understood that the physician 
assumes all responsibility. 

How to Administer the Chloroform. — Remove 
any foreign body from the mouth of the pa- 
tient, annoint the face, lips and chin with vaseline 
or olive oil to prevent burning by the chloroform ; 
the eyes are shielded by a folded towel to protect 
them against the irritating action of the drug. Just 
as the pain comes on, fifteen drops of cholorform is 
dropped on the mask or napkin, and the mask or 
napkin wet w;ith choloroform is held over the nose 
and mouth of the patient at the beginning of a pain. 

90 



After a few minutes fifteen drops more is dropped 
on the mask or cloth, and the gauze or cloth with 
which the mask is covered should be kept wet as 
long as the pains last. Give the anesthetic only during 
a pain. As soon as the pain is present ask your pa- 
tient to breathe deep and long, then give the chloro- 
from promptly at the beginning of the pain and re- 
move the mask as soon as the pain ceases. The 
doctor generally tells the nurse when he wishes the 
choloroform given, and the nurse watches the doctor 
for instructions as to whether he wishes more or 
less anesthetic given. The object is simply to blunt 
and lighten the pains of labor, and not to remove 
them. Mild anesthetige is the object aimed at. It 
is, however, pushed to unconciousness, during the 
passage of the child's head over the perineum, but 
ceases immediately the head is born. In administer- 
ing the choloroform, it should be remembered that 
to be taken in safety it should be diluted with ninety 
per cent of air. So care must be taken not to let the 
inhaler or mask approach the face too closely, not 
closer than two inches, as it Avould thus exclude the 
air. When ether is used, there is danger of explosion, 
and if there is a fire in the room choloroform should 
be substituted. Most physicians use chloroform now. 
It is a merciful plan and when given at this stage 
works perfectly. It is never given ivhile the pains 
are high up as it Avould stop the progress to some 
extent. Should the patient begin to vomit, turn the 
head immediately as far as possible to one side, to 
allow the vomited matter to escape from the mouth. 
Towels should have been prepared for such an 
emergency, and within easy reach. The patient's 
mouth should be wiped oft and a fresh toivel placed 

91 



under her head. In the absence of an inhaler or mask, 
the drug may be administered on a handkerchief or 
napkin. Drop the chloroform on it and hold it about 
two inches from the patient's nose, and in the absence 
of a dropper the cork is cut, a small portion being re- 
moved from the side, and the chloroform is dropped 
from it. And an excellent inhaler is made as follows : 

To Make the Inhaler. — Take a piece of writing- 
paper, fold it cone shape and have it large enough to 
cover the patient's nose and mouth. Cut the peak or 
point off. Insert a piece of absorbent cotton in the 
cone. Drop the chloroform in at the small or funel 
end. The point being - cut off the chloroform falls on 
the cotton, and the large end or base being over 
the patient's mouth and nose acts perfectly. This 
makes an excellent mask. Care must be taken that 
the inhaler does not touch the face or exclude the air 
as instant suspension of respiration may result there- 
from. 

After the head is born there is a cessation in labor 
for a brief period, when other uterine contractions 
again occur when the shoulders and the body of the 
child is born. The shock of expulsion and the cooler 
air causes the child to gasp and catch its breath, and 
it soon cries lustily. Thus the child is born gradually 
and the patient in the unconscious state is perfectly 
quiet, and the possibilities of lacerations are lessened. 
In case of a tear of the perineum, it should be closed 
by sutures immediately after the birth of the child, 
or otherwise, some portion of the birth canal will 
sag, and the support of the uterus being weakened, 
the uterus may assume an abnormal position and 
cause the patient a great deal of discomfort and suf- 
fering. 

92 



To Assist the Doctor in Preserving the Perineum. — 
During the passage of the child's head over the 
perineum, the nurse is often called upon by the at- 
tending physician to aid him in preserving the 
perineum. To do so take a sterile towel and as the 
head advances protect the perineum by making firm 
upward and backward pressure against the occiput. 
This diminishes the tention in the medium line where 
rupture usually occurs. Sometimes the parts will 
not dilate, but tear, or the physician to prevent a 
tear cuts the skin one eighth of an inch each side. 
This operation is called "Episiotomy." It is sewed 
after the birth of the child. As soon as the child's 
head is born, a slight pause occurs during which the 
eyes of the infant are washed with a saturated solu- 
tion of boric acid. This is the physician's duty, and 
a nurse should never attempt to assume this responsi- 
bility, unless told to do so by the attending physician, 
or when she sees he has neglected to do so. Under 
these circumstannces she may do so. The mucus is 
removed from the mouth of the infant as soon as the 
head is born by the physician, and the nurse should 
wash the baby's hands so nothing may be carried by 
them to the eyes. Some physicians employ the 
"Crede" method, which is the nitrite of silver solu- 
tion. One drop, not more, in each eye. It is then 
neutralized by flushing with a saline solution. This 
is security against infection. Other uterine contrac- 
tions occur and the shoulders and bod}' of the child 
is born. The birth of the child is usually followed by 
a large escape of amniotic fluid and blood, which has 
been kept in the uterus by the child's head. 

Tying the Cord. — The child is still connected with 
the mother by the umbilical cord, through which the 

93 



blood passes from the placenta to the child, and which 
serves as the lungs or breathing apparatus of the child. 
If the child does not cry, catch it by the feet, and hold 
it up, head downward and slap it, or throw cold water 
on the chest, or immerge it in warm and cold w r ater. 
Generally, however, the shock of birth and the ex- 
posure to the air is all that is necessary. As soon as 
baby cries vigorously, and is breathing normally the 
cord is cut. A certain amount of blood passes from 
the cord to the child for its strength and resistive 
forces and cutting the cord too soon robs the child of 
this amount of blood. But if the baby is strong and 
vigorous and is breathing properly, it is best to cut 
the cord shortly after birth, as some authorities have 
found upon investigation the liver of the child is not 
so apt to become engorged and thus it prevents 
jaundice in infants. But if it is a Aveak baby better 
wait until pulsation ceases. When the baby cries 
vigorously or the cord has ceased to pulsate, it is 
tied by two ligatures and cut between them. The first 






Fig-. 31— The above illustration shows us the method of tying the 
umbilicus cord and the binder applied. 

tying is about two inches from the umbilicus and 
again further down, about three inches, and cut be- 



94 



tween the ligatures. The pulsation in the cord lasts 
from live to fifteen minutes. The ligature on the 
placental end is to keep the placenta from becoming 
flat from the loss of blood, it requires more effort to 
expell it when it is flat. and. also, as a precaution in 
case of twins, the unborn child, if it were retained 
too long, might bleed to death. As soon as the cord is 
cut it should be wipped free from all blood, a piece 
of sterilized absorbent cotton is saturated with a one 
to two thousands bichloride of mercury solution, this 
is wrapped around the stump. The baby is then 
wrapped in the woolen blanket prepared for it, leaving 
only its little face exposed. An infant needs all the air 
it can possibly breathe to expand its lungs, which are 
usually not fully expanded until the second day. The 
little stranger is then removed to a place of safety. 
The napkin adjusted as already described, its little 
body and blanket are protected in case its bowels 
move. It is laid on its right side and kept warm by 
a hot water bag. The infant's colors should be pink 
or red, and its cry vigorous and strong, not a whiney 
wail. The nurse should then return to the assistance 
of the physician and attention is given the mother who 
generally lies perfectly quiet and exhausted by the 
great muscular effect she has been through. Some- 
times the birth of the child is followed by a nervous 
chill, this is not a serious condition, it is generally 
caused by shock on the expulsion of the child. The 
nurse should from time to time return and see if the 
baby is alright. Look and see if there is any oozing 
of the cord. Baby's have become quite weak from the 
loss of blood before this condition has sometimes been 
discovered. See that the baby is warm and properly 
breathing. That the little hands are wrapped so the 

95 



baby cannot get them to its eyes. This is one way 
of carrying infection, the infant getting its hands up 
to its eyes. The child's head should be lower than 
its body, so if there is any mucus in the throat, it 
can run out of the mouth. Xo further attention is 
given it until after the expulsion of the placenta and 
the mother is attended to and resting. 

Preparation for Forceps Operation. — If It is neces- 
sary to use forceps, the patient should be cleaned, 
the perineum, vulva and adjacent parts washed with 
a one in two thousandth bichloride of mercury 
solution. A bichloride pad in the strength of one in 
two thousandth is placed over the entire birth 
canal. All soiled and bloody clothes should then be 
removed. Then place the patient across the bed 
with hips close to the edge, the knees far apart and 
flexed back on the abdomen. It usually requires two 
assistants to hold the legs in this position. The 
sling sheet is best, it supports the legs and the nurse 
simply holds them apart. It is more satisfactory. The 
legs may be covered by wrapping- sheet around them, 
or better still the long leggins made of light weight 
flannel or outing cloth that is used for this purpose. 

Baptism. — If the family are catholics, the nurse, 
unless the physician has attended to the matter, should 
arrange for the baptism of the child when there is a 
possibility that the child will die. The doctor may 
give the child intrauterine baptism if there is a pos- 
sibility of death before birth. If the nurse is a 
Catholic, she should see that the child is baptized 
whether the parents are Catholics or not, when there is 
danger of death, but if the nurse is a non-Catholic and 
her patient is a Catholic, she should see that this duty 

96 



is not neglected 



\ non- Catholic may administer this 
rite. Take a cup of plain water, and while pouring- 
it over the infant's head or presenting part, say these 
words while pouring the water : "I baptize thee in the 
name of the Father and of the Son and of the Holy 
Ghost." 

Third Stage. — From the expulsion of the child to 
the expulsion of the placenta and membranes. As the 
child leaves the vagina, the nurse should follow down 
the receding uterus with the hand placed on the abdo- 
men. This is to avoid hemorrhage. After the birth of 
the child there is a rest of a few minutes, when other 




Fig-. 32 — Patient arranged for the conduct of the third stage of 

labor. 

uterine contractions are felt and the placenta and mem- 
branes are expelled. This stage usually lasts from fif- 
teen minutes to a half hour. In normal delivery the 
placenta descends folded vertically in the axes of the 
womb through the vagina. The passage of the placenta 
through the uterus to the vagina is indicated by the 



[-] 



97 



fundus of the uterus rising up about two inches above 
its previous position, and when this occurs firm pres- 
sure downward and backward in the direction of the 
vagina will force it out. Immediately after the birth 
of the child, the nurse should place one hand over the 
abdomen to secure contraction of the uterus and to 
ascertain if there is another child. The uterus should 




Fig. 33 — Nurse holding- the uterus during the third stage. 

be firmly held until after the expulsion of the placenta. 
A large bichloride pad is sometimes placed over the 
vulva and kept there until the placenta is expelled. 
After a short rest, during which the uterus can be 
felt as a round hard body just under the umbilicus, 
the pains re-occur, the uterus contracts and the 
placenta and membranes are expelled. 

The placenta usually leaves the uterus in fifteen 
minutes to a half hour after the birth of the child, 
and enters the vagina, whence it is expelled by the 
abdominal muscles. There is a loss of blood, but 

98 




Fig - . 34 — Twins placenta, showing arterial anastomosis. 

usually it is not abnormal. Chloroform is never given 
during this stage, as it favors the relaxation of the 
uterus and predisposes to hemorrhage. The nurse 
is usually required to hold the fundus while the doctor 
is otherwise engaged. It should be held gently but 
firmly, and by kneading in circular movements over 
the uterus through the abdominal wall aids much in 
the exciting of the uterus contractions. Never pull 
upon the cord ; this might produce serious complica- 
tions. As the placenta slips from the vulva, it should 
be caught and twisted round and round so as to re- 
move all the membranes. If bleeding is profuse or 
there is a hemorrhage, the physician usually in- 
structs the nurse to give the patient a teaspoonful of 

99 



fluid extract of ergot or a hyporderinic of ten mim. : 

ergotole. It is usually given immediately after the 
deliver}- of the placenta, whether there is a hemorrhage 
or not, as a precaution . The maternal organs are torn 
across and the placenta being removed, some hemor- 
rhage naturally follows. The empty uterus con- 
tracts into a hard, round, lirm ball, and is felt just 
above the symphyses pubes. Have readv for the re- 
ception of the placenta a clean vessel. Usually 
clean chamber and lid to cover it with, is best, and 
most convenient to get. Save it until after the exam- 
ination by the attending physician. Then destrov 
it by burning. This examination enables the phy- 
sician to know and determine if any parts of the 
placenta or membranes are left in the uterus. Any 
particles left in the uterus will decompose and cause 
septic poisoning. So in the absence f the physician. 
- ve everything for inspection on his arrival. The 
physician will inspect the placenta and membranes 
carefully to see that no pieces of either is left in the 
uterus, so the nurse should place the vessel contain- 
ing them where he will see them before he leaves the 
house. And it would not be improper for the nurse 
tc call the loctor's attention :: it if he should for- 
esee it. 

Douche After Labor. — Some physicians order, 
rather give it themselves, a douche immediately af- 
ter the expulsion of the placenta. It is usually a one 
t : five thousandths bichloride of mercury solution. 
The nurse should inquire of the physician the anti- 
septic wanted, as physicians have different methods. 

It is given to wash out blood clots from the vagina. 
and as an antiseptic precaution. Physicians differ in 
their opinion regarding the use of the douche. Some 



claim it is apt to do harm by carrying infection up in 
the vagina. But it is never given unless ordered and 
then the physician usually gives it himself. Some- 
times a hot douche is given to secure contraction of 
the uterus, and in case of post-partum hemorrhage. 
Some physicians use the pitcher douche of plain 
sterile water, using their hand to remove the blood 
clots. With the left hand placed over the uterus on 
the abdomen, the right hand is inserted in the vulva, 
then kneading the uterus through the abdominal wall 
with the left hand, forcing down, causing the uterus 
to contract, this forces down the blood clots, and at 
the same time using the right hand for manipula- 
tion through the vulva and removing them. The 
nurse pouring slowly and continuously hot sterile 
water 115 deg'rees. This treatment continued for 
about an hour. I have noted with this treatment 
very little blood is lost and the uterine contractions 
are firmer. A nurse should always prepare and have 
ready a sterile douche bag and nozzle. A glass intro- 
uterine douche nozzle ; a pint of sterile vinegar, and a 
sterile granite pitcher. Emergency might arise, and 
the life of the patient depend upon immediate 
remedies. Have everything in readiness in case the 
doctor may need them. 

Lacerations. — The physician will now examine the 
patient for lacerations. Should he refer this matter 
to the nurse, she should positively decline to do so. 
This is the physician's duty, and the nurse who would 
presume to assume this responsibility would expose 
herself to criticism. Many women date lifelong 
invalidism to the neglect of the proper repair of the 
pelvic floor and birth canal. 

The placenta expelled and the condition being 

101 



normal, there being no tear in the perenium, or none 
that require sutures, or if any the physician has re- 
paired them, the doctor usually instructs the nurse to 
clean and dress the patient. 

The Toilet and Care of the Patient Immediately 
after labor. — The first thing to do is to place a large 
pad of dry sterilized absorbent cotton over the en- 
tire birth canal to prevent any germ entering it. Place 
one of the sterilized towels that has been boiled in the 
bichoride solution under the patient over the labor 
pad. This is to make it safe and antiseptic. Place 
your patient on the douche pan. Disinfect your 
hands and immerge them for a few minutes in a one 
in two thousand bichloride of mercury solution. Gen- 
erally the hands are kept as clean as possible, during 
labor requiring to be immerge d only a few minutes in 
a bichloride solution. With clean hands separate the 
lavia and with a hot pitcher douche about 115 F. 
remove all the blood clots from the vulva. The douche 
consists of plain sterile water unless some disenfectant 
is ordered by the attending physician. Your vulva 
pad is now applied. It should consist of a thin piece 
of absorbent cotton, which has laid for several minutes 
in a one to five thousandth bichloride of mercury so- 
lution. This is wrung out as dry as possible and 
placed over the genitals. It should be large enough 
to entirely cover all the hairy part, so that no germ 
can get into the birth canal. Over this is placed a 
large pad of dry sterilized absorbent cotton. The 
body should now be cleaned of all blood and dis- 
charge, and all soiled linen removed from the bed. 
Wash the patient's buttocks, lower abdomen and 
thighs; any part of the body that is soiled. Remove 
the labor pad and all soiled linen and clothing and 

102 



replace with fresh, clean ones. If the labor has been 
conducted as herein described, towels used under the 
buttocks of the patient and each removed as soiled, 
there is nothing to remove but the labor pad. The 
night-gown rolled up under the arms neatly out of 
the way, as herein described, is usually perfectly clean, 
requiring no changing, and the labor pad made of 
newspapers and an old sheet, or newspapers and raw 
cotton covered over with cheese cloth can be re- 
moved, leaving the bed nice and clean. So using this 
method it is easier, cleaner and there is practically no 
washing for the lying-in woman, except the few towels 
used during labor over the labor pad. Should the bed 
or patient's clothing accidentally become soiled during 
labor, they must all be replaced with clean ones. A 
large pad made of cheese-cloth and cotton batting" or 
raw cotton (non-absorbent) or an old sheet folded 
and pinned to the mattress, so as to prevent wrinkling, 
should be placed under the patient's hips the first 
three or four days when the flow is the greatest, so as 
to protect the bed. Changed as often as it becomes 
soiled. The binder should now be applied. 

The Binder. — The binder should reach from the 
breast-bone to a point well below the hips, so as not to 
ride up when the patient turns in bed. A straight 
band of strong unbleached muslin is best for this 
purpose. The selvage torn off and unhemmed. They 
are more comfortable if laundried. This bandage 
should be adjusted so as to fit the figure. It can be 
closely and firmly fitted by pinning with safetv pins. 
Pin with safety pins, large size, beginning in the front 
at a point below the hips, draw the binder tightly 
and evenly and pin with a safety pin. Then pin the 
bandage even through the middle, using no tension. 

103 



Now lit it to the figure by pinning it firmly and 
tightly on each side, using large safety pins. Begin 
the fitting of the binder above and pin downward. 
Some authorities advocate placing a firmly rolled 
towel under the binder just above the fundus of the 
uterus to make additional pressure at this point. This 
is to assist in keeping the uterus contracted, and thus 
aid in the prevention of hemorrhage. Care must be 
taken that this towel does not slip and push the uterus 
to one side and thus cause misplacement and trouble. 
The towel may be removed in twelve hours. The 
binder serves to promote the comfort of the patient by 
supporting the lax abdominal wall, enabling her to 
turn with ease on her side, and the towel serves to 
promote the contraction of the uterus. Some phy- 
sicians use instead of the rolled towel adhesive plaster 
bandage. This bandage reaches from side to side. 
The adhesive bandage is about one and a half inches 
in width, using three widths ; it is pulled very tightly 
and reaches from the navel to a point just above the 
pubic arch. The object of this bandage is to bring 
the recti muscles together, and thus prevent the large 
pouting abdomen so often seen after labor; it also 
promotes the contraction of the uterus. This bandage 
is worn until the motner is up and well. 

The Occlusion Bandage. — The broad occlusion 
bandage that holds the vulva dressing is next applied. 
It is pinned with safety pins, two in front, one on 
each side, and the same way in the back. This, also, 
serves to keep, the abdominal bandage from riding 
up. 

After Pains. — Most women experience a restful 
feeling after the birth of the child and are inclined to 
be wakeful and talkative. In regard to after pains, 

104 



they should not exist. It is an abnormal condition, 
and a positive proof of the retention of a foreign body 
in the uterus, and the pain is caused by the contrac- 
tion of the uterine muscles to expel this foreign body. 

Temperature and Pulse. — The last thing to do is to 
take the patient's temperature and pulse. The tem- 
perature should be about ninety-eight and a half to 
ninety-nine degrees, and the pulse is somewhat slow- 
er than normal ; from sixty-five to seventy beats per 
minute. If it is more than one hundred beats per 
minute, look out for hemorrhage. 

Everything being in good condition, the room 
should be darkened, the mother should be kept per- 
fectly quiet and encouraged to go to sleep. There 
should be no loud talking in the room, no excitement, 
and no visitors allowed or admitted, not even relations, 
until after three full days, and then only the im- 
mediate family, only two a day, for a few minutes at 
a time. Their visits should not exceed ten minutes. 

The puerperal period now begins. 



105 



CHAPTER VIII. 

THE PUERPERAL PERIOD. 
Care of the Mother After Labor. 

Sleep After Labor. — After the patient's toilet is 
over and all percautions have been taken to guard 
against hemorrhage ; the pulse good, the uterus firm, 
and there is no bleeding from the vulva ; the abdominal 
and occlusion bandages applied, it is very desirable 
the mother should enjoy an hour or two of quiet, rest- 
ful sleep. Sleep relieves the exhaustion following- 
child-birth, and is a very important element in the 
restoration of the patient. To obtain this end the 
room should be darkened and absolute quiet reign, and 
the mother persuaded to go to sleep. The child should 
not be allowed to disturb the mother's rest. If it 
cries it should be taken into another room. 

It is best, if possible, to have a room for the baby 
separate from the mother's, and the infant taken to 
her at regular intervals to be nursed. 

Nourishment. — If the mother complains of feeling- 
weak or faint after the completion of labor, a cup 
of tea. broth or a glass of milk may be given her. 

The Position of the Patient. — The patient should 
lie on her back the first twelve hours after labor : 
if she turns on her side the heavy uterus falls for- 
ward and may draw air into the uterus, causing the 

106 



blood to clot, thereby causing obstruction and mis- 
placement. After the rirst day the uterus usually, in 
normal cases, contracts down firmly and there is no 
such danger. The patient lies on one side or the 
other most of the time, after the first day. not much 
on her back. This position, also, aids in the ex- 
pulsion of the blood clots. Do not allow your patient 
to lie too long on one side : if she does the uterus 
will incline towards that side. Examine the abdomen 
from time to time to see that this condition is not 
present. If so. turn your patient on the opposite 
side and matters will adjust themselves. 

Sometimes a full bladder or rectum will cause a 
misplacement. Watch these conditions carefully. 

Involution. — When labor is over the uterus im- 
mediately begins to return to its original size. This 
is called involution. 

Uterine Contractions. — The uterine contractions 
continue two or three days after delivery. They 
expel blood clots from the uterine cavity. Prevent 
hemorrhage by causing the uterus to contract down 
on the torn blood vessels, compressing them. Con- 
tracting the uterus, thus aiding it to return to its 
normal size. 

Bleeding. — In ca.^e oi excessive bleeding, give the 
patient a half teaspoonful of rluid extract of ergot 
every hour until the bleeding- is controlled, and 
.stimulate the uterus by putting the child to the 
breast, and knead the uterus by rubbing it in circular 
movements through the abdominal wall. Should 
there be a distinct hemorrhage more extreme measures 
must be taken. Give immediately a hypodermic in- 
jection of one-sixth of a grain of digitaline. and one 

107 



thirtieth of a grain of strychnine. A hot sterile 
douche of one in four thousandth bichloride of 
mercury. The temperature of the water should be 
one hundred and ten to one hundred and fifteen de- 
grees. Hot water is an astringent, contracting the 
blood vessels, and thus aids in the arrest of hemor- 
rhage. Notify the physician in charge of the case at 
once. 

Passing of Urine. — The bladder should empty itself 
in at least eight hours after delivery, and the nurse 
should have her patient try. The natural impulse 
to urination after delivery is feeble, even when the 
bladder is full. This retention is often relieved by 
hot fermentation to the parts and over the bladder, or 
by allowing- some warm bichloride solution, in the 
strength of one in four thousandth to flow over the 
parts while the patient is trying to urinate. If she 
can not start the flow, place several pillows under 
her shoulders to raise her a little, run the warm 
solution over the parts again and while the patient 
is bearing down, assist her by placing one hand over 
the bladder and making gentle pressure. If this is 
not successful, the use of the catheter will be neces- 
sary. Do not use the catheter without consulting the 
attending physician. Some physicians allow and en- 
courage the mother getting out of bed eight hours 
after delivery, if no complications exist, rather than 
use the catheter. Have a sterile slop jar, or a cham- 
ber placed on a box or stool to make it a convenient 
height, and allow the patient to get out of bed and 
sit on it, resting her head against the back of a chair. 
This position also aids in the expulsion of blood clots 
and there is practically no danger attached to it. 

108 



Catheterization. — In vising the catheter observe 
carefully the following directions. The catheter on 
such an occasion should be a glass catheter. The 
catheter, brushes and cotton we use for the cleaning 
of the hands and parts should be boiled in covered 
basins twenty minutes. The soap should be green 
soap or some sterilized liquid soap. The hands of 
the nurse are cleaned before using the catheter, as 
for a surgical dressing, according to directions al- 
ready given. The patient lies on her back on the 
bed pan, with knees drawn up and separated. The 
parts are scrubbed with a soft brush, soap and water, 
all of which are sterile. Then wash oft well with plain 
boiled water, afterwards flush with a one to four thou- 
sandth bichloride of mercury solution to thoroughly 
disenfect. The preparation in details is as follows : 
Place your patient on the bed pan and arrange the 
clothing so you can throw them back by placing your 
elbow under them. Now scrub and disinfect your 
hands, then throw back the clothing with your elbow. 
Have the patient separate the knees and scrub the ex- 
ternal parts well with the sterile brush, soap and water : 
wash oft with plain sterile water. Then separate 
the labia and cleanse the vestibule and meatus with 
sterile cotton, which is wet in a bichloride solution, 
one in four thousandth. Then wash off with plain 
boiled cotton, and insert a large piece of cotton in 
the vagina to prevent the danger of the discharge 
or flow coming in contact with the catheter. The 
catheter is then gently inserted. Remember the 
anatomy, do not push it, use no force. In taking hold 
of the catheter, take hold near the middle. Do not 
touch the point. If it does not slip in easily, dip the 
point in sterile vaseline, glycerine or sweet oil, but 

109 



use no force. After the nurse cleanses the parts, the 
labia must be kept separate until the catheter is 
introduced. Should the parts be allowed to come in 
contact, they must be cleansed again with antiseptic 
solution before the catheter is introduced. The urine 
is collected in a vessel. A graduate urinal is best. The 
end of the catheter is placed in the urinal and the urine 
received in it. Press gently over the bladder to be sure 
it is entirely emptied. Sometimes when the flow 
stops, if we pull the catheter down a little we will 
have another continuous flow. This is caused be- 
cause we have inserted the catheter too high, and 
when the water passes below the line of the catheter 
it ceases to flow. We should never insert the catheter 
any higher after the flow commences. "When remov- 
ing the catheter the finger should be placed over the 
end to prevent air getting into the bladder, and, also, 
from soiling the bed clothes. If the patient com- 
plains of a burning sensation after catheterization, 
apply a small compress of sterile cotton wet with 
cold sterile water. The external genitals are flushed 
with cool sterile water after each catheterization. 
They should, also, be flushed after each urination if 
the use of the catheter is not necessary. The 
evacuation of the bladder should be repeated once 
in eight hours, and the urine measured for the first 
nine days, to see if the kidneys are working properly. 
Hence if a graduate urinal is used to receive the urine 
in, if the catheter is used, there will be no waste, 
which necessarily occurs in pouring it from one 
vessel to another, but if the patient is able to void 
urine, and this is always to be encouraged, it will 
have to be received in the bed pan or slop jar, and 

110 



the urine emptied before irrigating-, and measured 
afterwards. 

This is one of the most important duties of a nurse, 
to catheterize properly. We must use aseptic cathe- 
ter. The hands should be surgically clean. Basins, 
brushes, soap and water and all articles used should 
be sterile. Otherwise we are apt to carry microbes 
or germs into the bladder and cause inflammation. 
This inflammation is capable of extending from the 
bladder to the pelvis of the kidneys, and even the 
kidneys themselves with fatal results. The principal 
means and the only way to prevent this, is care and 
absolute surgical cleanliness. 

The Bowels. — The bowels are usually sluggish. If 
there is no movement after forty-eight hours, give 
on the morning of the third day an ounce and a half 
of castor oil or a saturated solution of epsom salts 
two ounces, or a teaspoonful of the solution every 
hour until the bowels move, or give one half of a 
bottle of citrite of magnesia, followed by the re- 
maining half in two hours if the bowels have not 
moved. 

Diet. — The diet for the mother for the first forty- 
eight hours should be restricted to milk, one to two 
pints a day, gruel, soup, toast and butter with one 
cup of tea or coffee in the morning if desired. The 
first two or three days the patient is usually thirsty. 
and is indifferent to solid foods. After the bowels 
have moved on the third day the normal appetite 
usually returns, and a more liberal diet should be 
given, such as milk toast, poached eggs, soup, tapioca 
custard, oysters, white meat of fowl and after the 
fourth day a moderate full diet is given. The mother 

111 



needs as liberal a diet as she can take for her own 
nutrition and that she may supply the proper qualtiy 
and quantity of milk for the demands of the child. If 
the milk comes profusely on the third or fourth day, 
restrict or limit the amount of liquids until the flow- 
is controlled. 

Visitors. — No visitors should be allowed in the ly- 
ing-in chamber until after the expiration of three 
full days, and then only the immediate relatives, only 
a few the first week, and their visits of short dura- 
tion. Never more than two a day, and their visits 
should not exceed ten minutes. It is too trying on 
the mother, exhaust her strength and is apt to excite 
her, and visitors are sometimes thoughtless and in- 
considerate. They should be told when their time 
is up if they do not leaA'e promptly. 

Cleanliness. — "Cleanliness is next to godliness," 
and it is never so near true as in the lying-in chamber. 
Here cleanliness must reign supreme. I mean the 
cleanliness that goes beyond that which can be seen 
with the eye. I mean surgical cleanliness. Absolute 
cleanliness of the patient's person clothing, bedding 
and all instruments and dressings, the nurse's hands, 
and all that come in contact with the patient's 
genitals must be surgically clean. Great care must 
be taken to keep the external genitals clean. 

Vulva Dressing. — The vulva dressing should be 
changed every four hours the first three days, and as 
often thereafter as it becomes soiled, and after each 
bow'el movement and urination. The parts are bathed 
each time in a warm bichloride solution. To accomp- 
lish this place your patient on the bed pan and re- 
move the pad. The nurse provides everything she 

112 



will need close at hand before placing her patient on 
the bed pan. After placing her patient on the bed 
pan, she arranges the covers so they can be thrown 
back Avith the elbow. She then sterilizes her hands or 
uses sterilized rubber gloves. Rubber gloves should 
always be worn when the discharge is of an infectious 
character and there is a suspicion of gonorrhea or 
syphillis. The patient should urinate at this time, 
if possible, while the nurse scrubs her hands. Should 
the patient void urine, it must be emptied and after- 
wards measured, and if the patient's bowels move, 
the patient must be attended to before the nurse im- 
merges her hands in the bichloride solution. After 
attending to the wants of the patient, wash them 
again with soap and water and then immerge them 
in a bichloride solution in the strength of one in two 
thousand, or use the sterile rubber gloves. Wash the 
genitals gently by allowing the warm bichloride pitch- 
er douche in the strength of one in five thousand to 
flow over them at the same time washing the parts 
with sterilized absorbent cotton. The bichloride 
pitcher douche is followed by a warm sterile plain 
water pitcher douche, the parts are wipped dry with 
dry sterilized absorbent cotton. Apply a fresh clean 
sterilized dressing, and reapply the occlusion bandage, 
which should always be dry and clean. Never use 
a pad that has been removed, even if it be perfectly 
clean, and always before making any manipulation 
about these parts the hands of the nurse should be 
cleaned and disinfected as herein described. Allow 
nothing to come in contact or touch the genitals 
which is not surgically clean. The pad or draw sheet 
immediately under the patient should always be kept 
clean and drv. A general sponge bath is given the 

[ 8 ] 113 



patient each morning followed by a gentle alcohol 
rub. 

Sutures. — If there are any stitches in the perineum, 
the nurse must be very careful and not pull on the 
ends or knots in any of the manipulations in dress- 
ing or cleansing the vulva, and in removing the pad 
or dressing see that the ends do not catch in the pad 
and pull on the wound. In dressing these parts, 
use extra care in cleansing around each stitch. This 
is best accomplished by wrapping sterilized cotton 
around a toothpick, which has been sterilized by 
boiling, cleansing each stitch separately. Moisten the 
cotton, after wrapping it around the pick, in a one 
to five thousand bichloride of mercury solution and 
cleanse each stitch separately, using a fresh pick for 
each stitch. Should the patient complain of the ends 
of the sutures pricking her, the nurse should lay a 
thin layer of sterilized cotton or gauze on each side 
of the stitches and dust well with arristol or boric 
acid powder. At each dressing examine the wound 
carefully and see if the stitches are cutting through. 
If there is any irritation or swelling; any pus forma- 
tion around the stitches, and if so tell the doctor and 
call his attention to it at his next visit. Use all 
precaution to avoid stitch abscess. If the suture used 
is non-absorbent, the stitches are removed on the 
eight to the tenth day, and the nurse should have 
ready for the doctor, when he makes his visit, if 
the time can be anticipated, a sharp pointed pair 
of scissors, a pair of artery forceps and a pair of tis- 
sue forceps. All of which should be sterilized and 
ready for the doctor when he arrives. If the time of 
his visit is uncertain, have all ready and put the 
instruments on to sterilize as soon as you know he 

114 



is in the house. This is one of the advantages of 
having" an outfit as herein described, the nurse can 
save herself and the physician much annoyance by 
having little things ready, and not have to wait 
until the doctor comes and wait until he gets the 
instruments for the nurse, and then keep him wait- 




Fig-. 35 — Patient obliquely in bed draped with a sheet prepared for 
external examination. 

ing while she arranges and sterilizes them. For the 
removal of sutures and examination, the patient is 
placed obliquely in bed, the legs drapped with a sheet 
or the long leggins are worn. 

Ventilation. — Keep the air of the lying-in chamber 
fresh and pure. The fresh air should be admitted 
constantly from the outside through an open window, 
care being taken not to expose the patient to draughs. 
The sunlight should always be admitted, and the 
room kept clean, bright, warm and cheerful. 

Care of the Breasts. — Watch the breasts that they 
do not become caked. If the breast becomes over 

115 



distended, or hard tender lumps are felt, the breast 
must be emptied by gentle massage or the breast 
pump. Massage is preferable. To massage the 
breast, lubricate the hands well with cocoa butter or 
olive oil, and rub gently from the base toward the 
nipple. Continue this process until the breast is 
emptied and it is soft and even and free from all knots. 
It is best to control the flow of milk by bandaging, 
the breast will then secrete only the amount of milk 
the child can take, while massage tends to stimulate 
an abnormal secretion. If inflammed, it must not be 
rubbed, but apply a hot compress or a hot flaxseed 
poultice, and support its weight with a bandage. 

Care of the Nipples. — The nipples should be washed 
before each nursing with boric acid solution a table- 
spoonful to a pint of water. It is best to boil the 
solution a minute or two, as this thoroughly disolves 
it, then filter by pouring it through absorbent cotton. 

After the baby has nursed, wash the nipples off 
with fluid extract of witch hazel, rub a little borated 
vaseline into the nipple, and then place a fresh piece of 
absorbent cotton over the nipple. This is to protect 
them and absorb the milk that might ooze out. Be 
sure that these pads are always clean and dry. If 
neglected the milk oozes out on the cotton and dries, 
thus forming a hard rough surface. This scratches 
the nipples, irritates them and makes them sore. If 
the nipples are cracked and are very sensitive, apply 
a little borated vaseline and dust well with boric acid 
powder and use a breast shield when nursing until 

116 



healed. If the nipples are small or sunken much 
trouble may be saved by put- 
ting the infant to the breast and 
teaching it how to take hold before 





they became engorged. Any 
marked sensitiveness or redness of 
the skin should be reported to the 
physician at once. Report to the 
physician at once any signs of ab- 
normal occurence. I have found 
by keeping a small pleget of cot- Fig. 36— Dr. c. s. Ba- 
ton wet with a one in eight thou- con nipple shiel± 
sand bichloride solution over the nipples prevents 
soreness and tissues. It must be kept wet and 
changed each time baby nurses. 

Dr. A. N. Curtis Method.— Dr. Arthur N. Curtis, 
of St. Louis has introduced a method of nursing the 
baby that has many fold advantages, saving time 
and trouble for the mother, baby and nurse. With 
his permission I herewith give this method to the 
nursing public, feeling sure they will be as grateful 
as I was, and will realize its advantages. The follow- 
ing are the directions : 

The baby is nursed every four hours, using first 
the bare nipple, the baby is encouraged to take the 
nipple and the nurse should continue her efforts un- 
til the little stranger understands how to take hold. 
The next time baby nurses the nipple shield is used, 
alternately, nipple and shield. This rule observed, the 
baby takes the nipple every eight hours. The nipple 
unaccustomed to performing any funcition, by this 
method gradually accommodates itself and is not used 
abruptly or abnormally as the case would be if used 
every three or four hours. This is one of the causes 

117 



of soreness. The breast unaccustomed to any func- 
tion, immediately becomes full and distended and if 
suckeled every two or three hours as is the case after 
the third day when baby is nursed every two or two 
and a half hours. By using this method there is seldom 
any soreness or tenderness of the nipples ; cracks and 
fisures are rare ; the secretion is stimulated and renders 
nursing easier in the beginning as the suction will 
cause what fluid there is in the breast to flow with 
less effort, and if the nipples are small or sunken they 
are drawn out and developed. Should the nipples be- 
come tender use the shield entirely. After three or 
four days the nipple shield is discarded and baby takes 
the bare nipple at each nursing. The nipple receives 
the same care after nursing when the nipple shield is 
used, as if baby took the bare nipple. 

Nursing. — Every mother should nurse her child, not 
only for its Avelfare, but for her own good, unless her 
health interferes. The nursing of the baby causes uter- 
ine contractions to become stronger, and thus the 
mother recovers more quickly and completely when 
she can nurse her child. Mother's milk is a God-given 
food, which belongs by right of nature to the child, and 
nurses should use their influence to encourage moth- 
ers to nurse their babies. It is to be "deplored how 
many mothers there are who refuse, at first, to nurse 
their baby, preferring, as they will say, "to raise them 
on the bottle," so they will not interfere with their 
pleasure. But often a little persuasion on the part of 
the nurse, showing these mothers the injustice it is 
and what it means to the child, and appealing to her 
maternal instinct, this obstacle is often overcome. A 
good nurse's influence is very great, and she should 
use it for good whenever possible. No greater in- 

118 



heritance can any child receive than good health. In 
infancy the foundation is laid on which each future 
life is built. 

The child is put to the breast eight hours after 
birth, and not oftener than once in four hours after 
that until a free flow of milk is established. The 
breast is first washed off with a one in two thousand 
bichloride of mercury solution, which is allowed to 
dry, then the nipples and adjacent parts are washed 
before each nursing with a saturated solution of boric 
acid and sterilized absorbent cotton. After each 
nursing wash the nipple with witch hazel and anoint 
them with a little borated vaseline, and place a pad 
of absorbent cotton over each nipple to absorb any 
milk that may ooze out. If the wet bichloride com- 
presses are used, omit the vaseline. 

Feeding the Baby. — If the baby seems hungry in 
spite of nursing the mother, give it a small quan- 
tity of boiled water frequently, and do not pay any at- 
tention to any suggestions with regard to the necessity 
of feeding it. Nature is a wise provider, and if the in- 
fant required food earlier, would certainly have pro- 
vided it. The amount of nourishment obtained the 
first three days is small. It is not milk, but a thin 
fluid known as colostrum, which acts on the child's 
bowels and clears the intestinal tract of the meconium, 
and is infinitely adapted to the needs of the child. The 
nursing of the child helps to secure contractions of the 
uterus, often causing severe pains. As soon as the 
breast milk comes freely the baby should nurse every 
two hours, from six a. m. until ten p. m., and twice 
during the night, usually at one and four a. m., if 
awake. 

119 



THE POSITION OF THE MOTHER WHEN 
NURSING THE CHILD. 

When Lying Down. — When the mother is lying- 
clown the child lies flat on the bed, on its side, not on 
the mother's arm. The mother lies on her side, inclin- 



iW 








p^ 


K* 






s 


V 






' '■ ' \^ 


— -^— .— ' - iC5 ~ - 4 




; 




x'w 


^s^ *r^ 




. 


■ - # 







Fig-. 37 — Proper position for nursing an infant when lying down. 

ing slightly forward with the arm thrown backward 
under the head. In this position the breast is so 
placed that the child can take hold of the nipple with 
ease and comfort. The nipple should be pulled out 
with the thumb and index finger and then washed, and 
then baby is placed at the breast. A crying baby will 
not take the breast the first time. Take baby when 
partly awake, place him in the position described and 
rub his little head so as to rouse him, the nipple being 
on the same angle as his mouth, he usually takes it 
without much trouble. It may be necessary to 
moisten the nipple with a little sweetened water or 
a little milk squeezed from the breast, in order to 

120 



induce the baby to work, but usually a little persever- 
ance on the part of the nurse is all that is necessary. 

Sitting Up. — When the mother is able to sit up the 
infant is held with its little head on its mother's arm 




Fig. 38. — Proper Position for Nursing an Infant 'When Sitting- Up. 

in a comfortable position. She should have a low 
rocker chair without arms, and a foot stool for her 
foot to rest on. 

Regularity in Nursing. — Regularity in nursing is 
very important for two reasons : It aids and es- 

121 



tablishes proper digestion, and it helps to keep the 
flow of milk regular in quality and quantity. If 
the intervals are too long the milk becomes too 
thin; if too short the milk becomes too rich, and 
if nursed at irregular intervals the baby's stom- 
ach is upset. Digestion is the process by means 
of which food is changed and dissolved so it can be 
taken up by the blood and carried by the circulation 
to all parts of the body for its strength and building 
purposes. When a baby is nursed, the milk on en- 
tering the stomach meets with the different juices and 
ferments of the stomach. The hydrochloric acid 
causes it to curdle. By contraction of the stomach 
these curds are broken up and finally, dissolved and 
assimilated. This process takes two hours. Hence 
the nurse will see the necessity of regularity in nurs- 
ing. But if nursed regardless of order and regularity, 
or whenever the child cries, as some foolish mothers 
do, the stomach will rebel and baby will have indi- 
gestion and vomit its food ; because its little stomach 
is crowded ; one nursing is not digested before an- 
other is taken into the stomach. The milk, too, when 
baby is nursed irregular, decreases in quantity, and be- 
comes stronger in fats ; this, too, disagrees with the 
baby, causing indigestion. The quantity of milk se- 
creted daily by the mother's breast, usually under nor- 
mal conditions, depends upon the amount needed, the 
age of the child. If the mother is healthy, takes suf- 
ficient out of doors exercise, eats the proper amount of 
nutritious food, and drinks at least a quart of rich milk 
a day, she should have sufficient milk for the needs 
and nourishment of her child. The milk changes in 
composition and increases in quantity to suit the age 
and wants of the child. If on the other hand the 

122 



mother neglects to take the proper amount of exer- 
cise and fresh air ; does not take the proper kind or 
amount of nutritious food, nurses the child irregular, 
the milk will be found wanting in quality and quan- 
tity. The nurse should impress the importance of the 
observance of these simple rules on the part of the 
mother, so as she may be able to nurse her child. It 
is a duty she owes it. 

How Often to Nurse the Baby. — After the free flow 
of milk is established, usually about the fourth day, 
baby is fed ever}- two hours during the day, from six . 
a. m., until ten p. m. and two feedings at night, 
if he is awake. Xever wake a baby at night for food. 
The night feeding is usually about one and four 
a m., until baby is five weeks old. From five weeks 
to twelve weeks, baby is fed every two and a 
half hours during the day, from six a. m., until ten 
p. m., and one feeding at night, usually at two a. m. 
From three to five months every three hours during 
the day, usual hours, no feeding at night. From five 
to nine months a child is fed four times a day, and at 
this age strained cereals and broth are added to the 
mid-day meal. Babies are creatures of habit, if fed 
at regular intervals they can be so trained that they 
will awake or seem hungry only at the regular time of 
feeding. When the hour for feeding arrives, the child 
must be fed, and if asleep must be awakened for that 
purpose. Never wake a child at night for food. When 
a child that has been so trained cries for food before 
the regular hour, or awakes hungry at night, it is an 
indication that the milk is lacking in either quantity 
or quality. In such a case the analysis of the milk 
will show the cause. To decide if baby is getting the 
proper quantity or not, weigh the baby before nurs- 

123 



ing, allow it to nurse 15 minutes and then weigh it 
again. If the child's weight after nursing is not in- 
creased to correspond to the number of ounces it 
should consume at a feeding, then the milk is defi- 
cient in quantity and must be increased by the mother 
taking more liquids and milk producing foods. If the 
quantity is sufficient, then it is probably due to defici- 
ent quality, the milk is not rich enough and the physi- 
cian should be consulted, and the mother should eat 
foods of richer quality., those that contain more fats. 
Any deficiency in either quantity or quality will cause 
the baby to be fretful and restless ; cries frequently 
and does not seem satisfied after nursing. 

To Increase the Flow of Milk. — If the milk is de- 
ficient in quantity it may be increased by the mother 

taking fluids and milk-producing foods. Milk, if it 
agrees with the mother, is excellent for her, one pint 
of cream to two pints of milk, mix them and drink it 
during the day, between meals and on going to bed. 
Chocolate is very nutritious. Malt nutrine, soups and 
even water will increase the supply where the quantity 
is deficient. But if the quantity is sufficient, but does 
not seem to satisfy the baby, it is possible it is defi- 
cient in character, not rich enough to satisfy the child. 
and in such a case the physician should be consulted, 
who will take a specimen for microscopical examina- 
tion to determine the trouble, and give a diet list which 
will increase the quantity and supply the deficiency. 
If on the other hand, it is too rich in fats, it will upset 
the baby's stomach and cause indigestion, and., also. 
affect the bowels, causing frequent movements. 

Mixed Feedings. — Sometimes all efforts to increase 

the mother's milk fails, and the baby must be given 
something in addition. A child must never be taken 

124 



from the mother's breast merely beeause the supply is 
insufficient for its needs. So long as the mother's breast 
continues to secrete, the child must be given the bene- 
fit of it, if the mother is healthy and the milk fit for it. 
Sometimes the milk contains the colostrum which ren- 
ders it unfit for the baby. Mother's milk is not only of 
a character that can be easily digested by an infant's 
partially formed organs, but furnishes the substance 
needed for the child's growth and development of 
these organs that is not found in cow's milk or any 
other food. The deficiency of the nourishment re- 
quired for the child's growth and development is made 
up by supplementing the nursings by feedings with 
modified cow's milk. A bottle is substituted for as 
many feedings as is necessary. When the breast and 
bottle feedings are combined, both breasts should be 
nursed at each nursing. 

To Dry Up the Milk. — When from any cause it 
becomes necessary to dry up the milk or decrease the 
flow, the mother should pursue the opposite course 
described, "to increase the flow," using very little 
fluids, and drinking very little, if any, water. The 
bowels should move freely every day. A tablespoon- 
ful of epsom salts should be taken before breakfast. 
Belladonna ointment should be applied to the breast, 
care being- taken that it does not touch the nipple. 
A tight bandage is then applied. Cotton should be 
placed between the breasts and at each side, and a 
pad over them. This is to even the pressure, and to 
prevent any binding" or compressing of the tissues. 
The breast binder should reach from under the arms 
to a point below the breast, and should be put on as 
tight as can be borne and pinned with safety pins. 
A small bandage or strap is pinned in the middle of 

125 



the breast bandage in the back. The straps are then 
brought over the shoulders, suspender fashion, and 
pinned in front, on each side to keep it from slipping 
down. Or better cut a jacket as shown in illustration. 
It is more satisfactory and comfortable. 

The Temperature. — Take the patient's temperature, 
pulse and respiration in the morning about seven 
o'clock, at noon and about four o'clock in the after- 
noon until the case is dismissed. 

The Lying-in Period.— Most women expect per- 
mission to be given them to get up on the 
tenth or eleventh day. There is, however, no 
fixed rule about getting up at any set time. 
Not to get up until the tenth day is the customary 
rule in normal cases, but where the uterus does not 
contract properly, or there is a large tear in the peri- 
neum and must heal, a much longer period of time 
is required, and the longer the patient remains quiet 
and in bed, the better she will be. But no patient is 
allowed to sit up until the uterus is well contracted 
and returns to the pelvic cavity. And the mother 
should not go up or down stairs until after the third 
week. 

Convalescing Period.- — The period of convale- 
scence from child-birth requires about six weeks. 
It begins with the expulsion of the placenta, 
and is the time occupied by the uterus and 
its appendages in returning to their normal 
size and condition. There are cases where it ex- 
ceeds this length of time, and a much longer time is 
required. 

Morning Toilet of the Patient. — As soon as 
the patient awakens in the morning take her 

126 





^- — 


"T^i^x 


( < 




T^l 


v.. .. 




'""•••••"... 


[NAMCLED 
SCO onO DOUCHE 


5=^ 


'ig\ 39 — Perfection 


douche and 




bed pan. 





temperature, usually about seven or seven thirty 
o'clock. After washing her face and hands, and 
allowing her to brush her teeth, prepare an appe- 
tizing breakfast and serve as daintily as possible. 
Breakfast over; baby nursed; the mother has rested, 
and an hour has elapsed since her breakfast, proceed 
with the morning toilet. Place your patient o^ the 
............. . bed pan and remove the 

vulva pad, and she should 
try and have a movement 
of both bladder and 
bowels. Then, after pre- 
paring and having within 
easy reach sterile basins, 
cotton, soap, water, a 
warm bichloride solution in the strength of one in 
five thousand, and the pitcher douche of plain steril- 
ized water, the nurse cleans her hands. (The nurse 
should always keep the basins, brushes, soap and 
water sterile so they will alwjays be ready, sterilize 
them as soon as finished using- them. The}- will then 
be always ready in an emergency), The bed pan is 
now removed and emptied and replaced under the 
patient. The nurse now washes off her hands with 
soap and water again, and then emerges them in a 
bichloride solution in the strength of one in two 
thousand. Rubber gloves are very nice, they save the 
hands, and in cases where the discharge is of an in- 
fectious character, they are very necessary. The 
nurse then washes the genitals with sterilized cotton, 
sterile soap and water. Wash off all soap thoroughly 
with plain sterile water. Separate the labia and 
flush the vulva well, removing all blood clots. The 
bichloride solution pitcher douche is followed by a 

127 



pitcher douche of plain sterile water. Wipe dry with 
plain sterilized cotton. Then the usual dressing. The 
first four or five days a thin bichloride pad is kept 
over the genitals to prevent infection. After wiping 
the parts dry, apply a thin piece of sterilized cot- 
ton wrung out of a one in five thousand bichloride 
solution over the genitals. Have it large enough to 
entirely cover the birth canal and hairy region. Over 
this a large piece of dry sterilized absorbent cotton. 
Now remove the bed pan and wash the thighs and 
buttocks with warm water and soap, remove the ab- 
dominal binder and wash the abdomen and back with 
soap and warm water. Wipe dry with a clean towel, 
and give a gentle alcohol rub. A clean abdominal 
binder is now applied, fitted well into the figure at 
the sides with safety pins. See that the room is the 
proper temperature, so as not to chill the patient. 
As soon as a part is washed dry immediately, then 
rub the part with alcohol, and cover. Expose only 
the part that is being washed so as to avoid chilling 
the patient. Watch the uterus carefully, see that 
it contracts properly and keep it in the median line. 
If it inclines to either side, keep the patient on the 
opposite side and nature usually adjusts matters. If 
too large or abnormally sensitive the physician 
should be informed at once. All physicians do not 
give these matters their personal attention. Some 
leave this condition to the supervision of the nurse, 
and she should be very careful. After applying the 
abdominal bandage, the occlusion bandage is applied. 
It should be pinned tightly in front with two safety 
pins, one on either side, and the same way in the 
back. The patient's night gown is now removed and 
the rest of the body bathed with warm water and 

128 



soap., followed by an alcohol rub. Then a clean night 
gown is put on. If the sheet is the least bit soiled 
it must be removed and replaced by a clean one. If 
not soiled it should be made smooth and free from all 
folds and wrinkles. A clean draw sheet or pad is al- 
ways put on. This should be put on fresh and clean 
even if it is not soiled. It is usually damp with per- 
spiration, and absorbs the odor. The hair is then 
combed and braided into two braids. It is best to braid 
the hair in two braids while the pattient remains in 
bed. as it is easier to comb. The patient can turn hrst 
on one side and then on the other in combing the hair 
and the exertion is not so great. The patient may 
now be placed on the other side of the bed : a glass of 
milk given her. and she usually takes a nap. 

This is the daily morning toilet of the patient as 
long as she remains in bed. In the evening a fresh 
dry gown should be put on. the back rubbed with 
alcohol and the patient moved to the other side of the 
bed. 

To economize in washing, if the gown removed in 
the morning is not soiled it should be hung out in the 
sun to dry and air. and used again at night. 

HOW TO CHANGE THE PATIENT'S BED. 

To Change the Under Sheet. — Remove all covers 
but the sheet. Move the patient to one side of 
the bed. as close to the edge as possible to be 
comfortable. If the patient is able she may move 
herself slowly over, if too weak, and there is a 
tear in the perineum, which necessitates her be- 
ing careful not to make much of an effort, allow her 
to put her arms around your waist. The nurse then 
places her hands under the patient's back, and an as- 
sistant on the oposite side of the bed likewise places 

io] 129 



her hands under the patient's back, and together the 
nurse and her assistant, in a swinging movement, are 
able to move the average patient without much effort. 
But the nurse should never attempt to lift a patient 
without assistance. Now roll and fold the under 
sheet and draw sheet close to the back. Against the 
soiled sheet, the clean sheet, half rolled, is placed. 
Spread the unrolled part of the clean sheet smoothly 
over the exposed part of the mattress and tuck it 
firmly in. Pin with safety pins if necessary to keep 
it smooth and firm. Place the pillow with a fresh 
clean slip on it on the clean side of the bed. Now 
simply turn your patient on her back, then let her 
turn on her side over on the clean sheet. If there is any 
reason why the patient should not move she must 
be lifted to the other side of the bed, and the nurse 
must have an assistant, if no other can be had call in 
a neighbor. Remove the soiled sheet and unroll the re- 
mainder of the clean sheet over the rest of the bed. 
Draw it smoothly and tuck it in under the mattress. 
Pin if necessary. The draw sheet is then adjusted. 
It is first placed smoothly over the under sheet on 
the side of the bed opposite that occupied by the pa- 
tient. Tuck it well in at that side. The remainder 
of the sheet is rolled or folded close to the side of the 
patient. The nurse returns to the side of the bed on 
which the patient is lying. The patient raises her 
body a little, in the same manner in which she would 
for the adjustment of a bed pan, and the nurse quick- 
ly pulls the remainder of the sheet through and tucks 
it well in. 

To Change the Draw Sheet. — When it is only neces- 
sary to change the draw sheet, it is placed smoothly 
across the bed over the lower sheet and should be 

130 



wide enough to reach from the middle of the patients 
back to her knees, and should be long enough so as 
it can be tucked well under the mattress at both sides 
of the bed to hold it firm so it will not wrinkle. When 
soiled it can be easily removed according to direc- 
tion already given. The draw sheet should always 
be kept clean and dry. and changed each morning 
whether soiled or not. 

To Change the Top Sheet. — Loosen the soiled sheet 
from the foot of the bed. Spread the clean sheet 
over the soiled one and tuck it in at the foot. Then, 
while holding the clean sheet with the left hand, 
draw the soiled sheet out with the right one. After 
which spread the remaining bed clothes on the bed. 



131 



Chapter IX. 

COMPLICATIONS DURING LABOR. 

Management of the Birth of the Child in the Ab- 
sence of the Physician. — The most common compli- 
cation the nurse is apt to meet is the deliver of the 
child before the arrival of the physician. It is 
perhaps more often in obstetrics than in any other 
illness that the nurse is called upon to assume, 
in the absence of the physician, the responsibilities 
that belong to him. She should understand 
the condition of things preceding labor. There 
are certain things she should know and understand. 
She should know how to tell the part presenting by 
external examination early in labor, and if it seems 
possible the child will be born before the arrival of 
the physician, she should know the position of the 
child. To make an internal examination introduce 
the fingers into the vagina during an interval be- 
tween pains until it reaches the open mouth of the 
uterus. The membranes are then lax, and the pre- 
senting part of the fetus head can be felt. Position 
refers to the part of the child's head presented. We 
can tell the position of the child by the anterior fon- 
tanelles, the soft, triangular opening in the skull. 
This name was given the opening because the beat- 
ing of the blood in the brain can be seen at this point 
in the rise and fall of the membranes covering the 

132 



brain, as this movement resembles the rise and fall 
of a fountain, it has been called the fountanelles. 
It often happens that the nurse will be alone with the 
patient during labor, the physician does not reach 
the house in time and the nurse is called upon to as- 
sist in the delivery of the child without the assistance 
of the doctor, and she should have sufficient knowl- 
edge of this branch of nursing to be able to conduct 
it without assistance in an emergency, as the life of 
both mother and child will often depend upon her 
skill. The nurse should not assume this responsibil- 
ity alone. It is best, when the physician cannot be 
had, to call someone else in. While in perfectly nor- 
mal cases everything may be alright and there is no 
danger, if the nurse should be unfortunate and lose 
the baby she might be unjustly blamed. And if she 
forceably holds back or prevents the birth of the 
head, it might injure both mother and child, she may 
hold it back as she has seen the physician do, so as to 
give the perineum time to stretch, and if the patient 
is having very hard bearing down pains, the nurse 
may place her on her side and ask her not to bear 
down during a pain, and give her a little chloroform, 
and the progress may be retarded if the head is not 
visible at the vulva. When the child is about to be 
born, and the physician has not arrived, place the 
patient on her back with knees drawn up. Then the 
nurse cleans her hands as for a surgical operation, ac- 
cording to directions already given. Be sure the}' are 
well scrubbed and clean. After immerging them for 
a few minutes in a one to two thousand bichloride of 
mercury solution, clean the patient's external geni- 
tals, after which the patient is brought across the bed 



towards the light. 



133 



The clothing should be thrown back and the nurse 
should watch the perineum. Place a basin of bi- 
chloride solution, in the strength of one in two thou- 
sand, with pieces of sterilized cotton in it to use to 
wipe away any discharges that may escape from the 
anus, care being taken in doing so not to soil the 
hands. The nurse disinfects her hands thoroughly 
and assumes the position of the physician. 
She should observe the same rules in regard to the 
preservation of the perineum as the physician does, 
namely, allow the head to come through slowly and 
between pains. About an hour and a half before the 
head is born the pelvic floor bulges out during a pain 
and the child's head becomes plainly visible. The 
nurse watches the rectum, which now opens, that no 
discharge escapes. The basins with the cotton and 
solution should be close at hand and she wipes all 
discharge from the vulva with antiseptic solution. 
As the child's head becomes visible at the vulva dur- 
ing a pain and causes it to bulge outward, the nurse 
should gentlv restrain the birth of the head by pres- 
sure on it with her fingers during a pain. Pressure 
upon the perineum during a pain to diminish the ten- 
sion in the medium line where rupture usually oc- 
curs. To accomplish this, when the presenting part 
begins to distend the vulva, the nurse should place 
the right hand against the perineum about half an 
inch from the orifice of the vulva, and as the head 
distends the vulva the nurse should support the peri- 
neum and pelvic floor by making firm upward and 
backward pressure, and if the head is being driven, 
as it were, with too much force, the nurse gently re- 
strains the birth of the head by pressure on it with 
the fingers of the left hand during a pain, asking 

134 



your patient not to bear down, but open her mouth 
wide and breathe during- a pain, and watch your op- 
portunity to let the head slip slowly out between 
pains. 

After the perineum is stretched so that it seems as 
though the head may come through in the interval 
between pains, ask the patient to bear down a little and 
the head will come. Thus the head is born gradually 
and the possibility of a tear is lessened. If the head 
sticks against the pubis, sometimes by a movement 
of the ringer Ave are able to relieve this pressure and 
the difficulty is adjusted. The head is the largest 
part, after it is born the rest of the body easily fol- 
lows. After the head is delivered insert the ringers 
in the passage and see if the cord is around the child's 
neck, and if so loosen it by drawing on the placental 
end until it can be slipped over the head or the shoul- 
ders can pass through the loop. If this is impossible, 
either because the cord is too short, or because it is 
wound several times around the child's body, a liga- 
ture should be applied and the cord tied, or if in a 
hurry, and the child is in danger, and you want to 
save time, a pair of artery forceps should be applied 
to both fetal and placental ends of the cord, these, 
of course, should have been sterilized by boiling 20 
minutes, in anticipation of an emergency, and ready. 
and the cord cut between the ligatures or forceps, 
and labor hastened by artificial efforts. This con- 
sists in rubbing the uterus with the hand in circular 
movements through the abdominal wall. This ex- 
cites labor pains, during which ask your patient to 
hold her breath and bear down and the child is Usu- 
allv expelled spontaneously. 

135 



After the delivery of the head the first thing to do 
is to wipe the mucus from the nose and mouth with 
cotton, wet in a saturated solution of boric acid, and 
remove it from the throat by inserting the finger, so 
that when the child gasps nothing can be drawn into 
its lungs. The eyes should then be carefully cleaned. 
Wipe all the secretions carefully from the lids with 
little cotton balls or plegets and a saturated solution 
of boric acid, which has been prepared for that pur- 
pose. Wipe from the eye-ball or nose, never towards 
it, using a fresh cotton ball or pleget each time. Be 
sure they are clean. Children have gone blind from 
neglect of this kind. Support the head with the hand 
and see that it does not lie in the discharge. After 
the head is delivered insert the fingers and draw the 
arms of the child down, they are folded across the 
chest, and when drawn down aid much in the delivery 
of the body. If difficulty is experienced, hook the fin- 
gers in the arm pits and extract the shoulders. But it is 
best, nearly always, to let nature take its course, 
unless we are sure of the position. It usually comes 
safely. It requires an educated touch, and we might 
injure some of the membranes. 

When the shoulders of the child is born the head 
of the child should be raised up with the left hand 
while the right hand guards the perineum. If the 
child seems asphyxiated the nurse should use those 
methods to resuscitate the baby as Avill be found in 
chapter on "The ills of the baby," elsewhere in this 
book. If the nurse has to give her attention to the 
baby she should have someone to hold the fundus of 
the uterus, and see that it does not relax. In normal 
cases, as soon as the child is born, the nurse places it 
a short distance from the mother so she will not press 

136 



on the child or cord or injure it with her feet, on its 
right side, and covers it with a warm towel, and then 
grasps the fundus of the uterus through the abdomi- 
nal wall, but does not massage it unless there is a 
hemorrhage. The nurse should have an assistant to 
help her. if there is none in the house, call some mar- 
ried woman, in the neighborhood, that can hold the 
fundus, while the nurse gives her attention to the 
child. If the cord is not beating, it must be tied im- 
mediately and the baby made to cry or it will be as- 
phyiated. 

Tieing the Cord. — The cord should never be tied 
except in conditions described above, until the child 
breathes and cries lustily. If the child is white, or 
blue, don't interfere with the cord until the child cries. 
If it does not cry throw cold water on the chest or 
back, it will then gasp and catch its breath ; or catch 
it by the feet, hold it up, head downward, and spank it. 
This usually suffices. If. however, it does not respond 
to this treatment, artificial respiration must be given. 
There are several methods which are described in 
chapter on "The ills of baby." After baby is breathing 
properly and the pulsation has ceased, the nurse may 
wait until the delivery of the placenta before cutting 
the cord, unless the mother has a hemorrhage. In the 
meantime the doctor may arrive, and will appreciate 
this thoughtfulness on her part, and there is no dan- 
ger attached to it for the child. If, however, the pla- 
centa is expelled, or it is desirable to separate the 
child, the cord should be tied about two inches from 
the navel and again further down, and cut between, 
close to the umbilicus end, using sterile scissors. If 
the cord is not left long enough to fold over to one 
side, it is very difficult to dress it as it should be, and 

137 



often produces a "pouting" navel, and may result in 
an umbilicus hernia. Narrow, flat linen bobkin tape 
is the best ligature. The most important reasons for 
tieing the cord twice is the possibility of twins, if 
not tied securely the unborn child might be bled to 
death. The tieing of the placental end, also, prevents 
the placenta from becoming flat from the loss of 
blood. It is not so easily expelled when flat. The 
nurse should tie securely both the fetal and maternal 
end of every cord before cutting it. After the cord is 
cut it should be wiped free from all blood and a piece 
of sterilized absorbent cotton saturated with a one 
in two thousand bichloride solution is wrapped 
around the stump. The baby can then be Avrapped 
in the warm blanket prepared for it and removed to 
a place of safety. The medical profession defers tie- 
ing and cutting the cord in weak babies until pulsa- 
tion has ceased, g-iving as the reasons that a certain 
quantitv of blood passes from the placenta to the 
child and thus increases its strength and resistive 
powers. To tie the cord immediately after the birth 
would rob the child of this blood, which would other- 
wise pass into its circulation, and a delicate, weak 
babv has need of all the blood it can take, and as a 
proof is found on experience which I have witnessed. 
Cases where the physician has deferred tieing the 
cord until pulsation had ceased. The cord is pale 
and when cut very little if any blood is lost. Where, 
as in some cases I have seen where the physician tied 
and cut the cord immediately after the birth of the 
child, the cord was red in color, and when cut quite 
a large amount of blood escaped. So in the absence 
of the physician it is best, and safer, if there are no 
complications, and the baby is weak, to wait until 

138 



pulsation has ceased. Late lagation is not dangerous. 
The child will take into its system only the amount of 
blood required for its needs. A strong, vigorous 
baby, the cord should be cut shortly after birth, as 
the little heart's functional activity is very great and 
too much blood is sent to the liver. This causes an 
enlarged, congested condition which often results in 
jaundice. 

Delivery of the Placenta. — From the time baby ar- 
rives, special attention should be directed towards 
uterine contractions, delivery of the placenta and 
avoidance oi hemorrhage. From the birth of the 
child there should be someone to hold the fundus 
of the uterus, to prevent it becoming lax. To 
hasten contraction of the uterus and expulsion of the 
placenta apply friction by circular movements through 
the abdominal wall to the fundus of the uterus until 
contraction is obtained. Make no effort to deliver 
the placenta until the mother has uterine contrac- 
tions. When the mother has pains and the uterus 
contracts down, the nurse should assist the pa- 
tient by grasping the fundus sc as it will rest in 
the palm of the hand, compressed between the 
thumb and hnger, and press downward in the direc- 
tion of the pelvic canal. "When the placenta appear 
at the vulva grasp it and twist the cord and mem- 
branes round and round. Never pull on the cord or 
you may have serious consequences. Continue the 
circular movements until the placenta is expelled. 
By twisting the cord and membranes you form a 
rope-like cord and nearly always all are expelled. 
The placenta will, as a rule, be expelled spontaneous- 
ly. The uterus, however, if left unaided is apt to re- 
lax and cause hemorrhage, or where expulsion does 

139 



not take place speedily, in a reasonable length of 
time, the uterus may close down so as to retain the 
placenta within the uterine cavity. So by contraction 
of the uterus hemorrhage is avoided, and speedy ex- 
pulsion guards against the danger of retention. Af- 
ter the expulsion of the placenta a teaspoonful of flu- 
id extract of ergot may be given as a safeguard and 
additional security against hemorrhage, and knead 
the uterus firmly until contraction is excited. The 
kneading should continue for one hour. This is a 
safeguard against hemorrhage, and by the prevention 
of the formation of blood clots, diminishes the severi- 
ty of the after pains. Save the placenta for the doc- 
tor's inspection. By this examination he is able to 
tell if any of it or the membranes are left in the uter- 
us. The smallest particle remaining in the uterus 
will decompose and may cause septic poisoning. The 
doctor usually reaches the house before the delivery 
of the placenta. If, however, the placenta is deliv- 
ered and the physician has not vet arrived, and the 
patient is bleeding considerable, 15 M, of ergotole 
hyperdermically may be given. Ergot, in any form is 
never given while the uterus contains either the fetus 
or the placenta, as it might close down tight and re- 
tain them in the uterine cavity. As soon as the uterus 
contracts down well the binder is applied. Mother's 
and baby's toilet according to directions given else- 
where. 

Other Presentations. — While the head is the normal 
and most frequent presentation, the infant may pre- 
sent any part of the body at the pelvic opening. 

Breech Presentation. — In breech presentation, the 
delivery of which requires more skill and labor than 

140 




Fig-. 40— Vertex presentation. (Pinard.) 




Fig-. 41— Presentation of the breech. 

141 



the normal position, the head. Position of the pa- 
tient the same as head presentation. When the breech 
appears at the vulva ask the patient to bear down 
during the pain, and by gentle pressure over the 
uterus, in the direction o;f the pelvic canal during the 1 
pain, assist the paitient if possible. As the breech emer- 




Fig. 42 — Delivery of after coming- head by flexion through seizure 
of lower jaw. 

ges the legs df the child drop out and the nurse should' 
receive and support the body as it is delivered. After 
the shoulders are born, the nurse should insert the 
finger of the right hand in the child's mouth, and with 
the left hand press upon the uterus and hasten the 
delivery of the head, or the child may be asphyxiated. 

Arm or Transverse Presentation. — In arm or 
transverse presentation send for the physician nearest 
at hand. The responsibility is too great for delay. 
The position must be changed or both lives may be 
lost. So if the nurse is not certain of the position, 

142 



and the conditions are not normal, if the physician 
cannot be had that has charge of the case, don't wait 
until it is too late, but send for the nearest physician. 

Prolapse of the Cord. — This is a very rare occur- 
rence, yet one of great consequence, and one that 
every nurse should be familiar with, the presentation 
of the umbilicus cord. It is a very serious condition 
for the child. When the cord presents at the vulva, 
the nurse will easily recognize the cord and she should 




Fig. 43 — Knee-chest position. 



send for a physician immediately. While waiting his 
arrival place the patient in the knee chest position, or 
elevate the hips by placing several pillows under them 
and with a large pad of sterilized absorbent cotton the 
nurse closes the vaginal opening and holds the pad in 
place by firm pressure against the vulva with the hand 
being careful not to press on the cord. There is no ad- 
vantage gained by putting the cord back in the va- 
gina. To be of any consequence the cord must be 
put back beyond the crevical os. This is impossible. 

143 



So should a nurse have a case of prolapse of the cord, 
send for the physician at once, and while awaiting 




Fig-. 44 — The elevated Sims' position. 

his arrival keep the patient in the knee chest position, 
If the patient complains of dyspnea or much dis- 
tress the elevated Sims position is preferable. 

HEMORRHAGES. 
General Direction. — One of the greates dangers at- 
tending child-birth is hemorrhage. This may take 
place either before, during or after the birth of 
the child. Where hemorrhage occurs keep in mind, 
in such a case, there are two things to do, to con- 
trol the hemorrhage and revive the patient. To 
revive the patient before stopping the flow of blood 
would aid her in pumping out her heart's blood. So 
the first thing to do is to stop the flow of blood 
and then revive her. To stop the flow of blood 
from an artery, pressure should be applied above 
the wound. An important fact to remember is 
where the blood is coming from and the course 
of the blood vessels, to know where to apply 
this pressure. The uterus is supplied with blood 
vessels that come through the broad ligament from 
each side, and it is difficult to bring pressure to bear 
directly upon these vessels. But we can stimulate 
the uterus so it will contract down on and compress 

144 



these arteries by kneading the uterus in circular 
movements through the abdominal wall : knead firm- 
ly and if the uterus will not respond to stimulation. 
ice sometimes applied to the abdomen will stimulate 
contractions. The pillow should be removed from 
under the head of the patient and the foot of the bed 
elevated about two feet, by placing a chair or box or 
table under it. this is to get the blood back to the 
brain. Open the window and let the patient have 
plenty of fresh air. being careful not to allow 
draughts, and keep her covered. 

If bleeding has ceased or has been controlled, the 
patient should now be given a stimulant to revive 
her. Give whiskey, aromatic spirits of ammonia, hy- 
podermic injection of one-thirtieth of a grain of 
strychnine and a cup of black coffee. If all efforts to 
secure contraction of the uterus fail give a douche 
of one pint of sterilized vinegar. This will usually 
cause contractions when all the other methods fail. 
It is usually the last we resort to. as it is best to 
avoid manipulation of the birth canal if possible, be- 
cause of the danger of carrying germs and infection 
into it from without. 

Placenta Praevia Hemmorrhage. — One occuring 
during labor sometimes and which is very serious is 
the placenta praevia hemorrhage, it is the most 
dangerous one of all hemorrhage? of the child- 
bearing period. It is usually caused by the 
wrong attachment of the placenta and is often fatal. 
The blood simply gushes forth. The best way. if 
any, to control this kind of a hemorrhage is to have 
someone make firm, continuous pressure on the ab- 
dominal artery while the nurse packs the vagina as 
tight as possible and send for the physician imme- 



10: 



145 



diately. The contiuous pressure on the blood ves- 
sel will prevent the further escape of blood. To ac- 
complish this the nurse should kneel on the bed by 
the side of the patient so as to be in a position where 
she can use the pressure to the best advantage possi- 
ble, she should rest her arm against her side so as 
to use all the force she can bring to bear on this 
large blood vessel. This treatment must be contin- 
ued continuously until the arrival of the physician. 
This treatment has saved many lives. 

Post Portum Hemmorrhage. — One immediately 

after labor or delivery is known as post portum 
hemorrhage. It is not an uncommon event ; it may 
follow the easiest normal labor, and in a few minutes 
carry the patient to death's door. It is caused by 
failure of the uterus to contract down properly 
and lacerations of the blood vessels in the cervix 
of the uterus. The danger does not end with the ex- 
pulsion of the placenta. The nurse should watch her 
patient closely for several hours. Should the uterus 
become lax, knead it until it contracts down firmly, 
and hold it, and do not let it soften again. If it be- 
gins to soften or relax, stimulate it by kneading 
through the abdominal wall. If the uterus is so soft 
it cannot be felt, knead it very vigorously and it will 
usually contract down. The uterus is very sensitive 
to massage and it usually responds to this treatment. 
Should this treatment fail to control the hemorrhage 
and the uterus, in spite of kneading, remain lax and 
soft, put your hand up in the uterus and with a 
piece of sterile gauze wet in sterilized vinegar swab 
the uterus well. Carry the gauze saturated with 
vinegar up into the cavity of the uterus with the 
right hand and with the left hand press very hard 

146 



down upon the uterus and try and make it contract. 
If you cannot get sterilized vinegar, use unsterilized 
vinegar and follow by a hot bichloride douche in the 
strength of one in four thousand, and the tempera- 
ture of the water should be from one hundred and ten 
degrees to one hundred and fifteen degrees F. Hot 
water acts as an astringent, contracting the blood 
vessels. It, of itself, will often stop bleeding. This 
is an emergency, when in order to save the woman's 
life, you must act quickly. Life depends on the rapid 
action of the nurse. If the physician is not there she 
should keep her presence of mind and observe all an- 
tiseptic precaution as far as she is able. Give, as 
soon as contractions are secured, a hypodermic in- 
jection of 15 m. of ergotole. Ergot, by mouth, acts 
too slowly to prove of service in an emergence}", it is 
nauseating to some patients and may not be absorbed 
by the stomach. If the hemorrhage is large and the 
patient seems w^eak ; after the uterus has contracted 
well down, give a hypodermic injection of one-fiftieth 
of a grain of digitaline and one-thirtieth of a grain of 
strychnine and watch the patient carefully until the 
physician arrives. 

Recurring Hemorrhage. — Hemorrhage occuring dur- 
ing puerpurium is termed recurring hemorrhage 
It is caused either by the separation of a thombi from 
the placental site, or a congested condition of the 
endometrium, the mucus membrane that lines the 
cavity of the uterus. The treatment consists in quiet 
rest in bed and hot -vaginal douches. Ergot is usually 
given three times a day, a half a dram, for several 
days as a security against reccurrence. Should it 
continue the uterus should be packed with sterile 



147 



Hemorrhage of Abortion. — For hemorrhage fol- 
lowing abortion, the only treatment is to pack the 
vagina tight with sterile gauze and give one dram of 
fluid extract of ergot. This usually is all that is neces- 
sary. 

Secondary Hemmorrhage. — A hemorrhage occuring 
several days after a previous one has been controlled, 
is known as a secondary hemorrhage. It is usually 
controlled by giving a teaspoonful of fluid extract 
of erp-ot and stimulating the uterus bv massasre. 

Symptoms of Hemorrhage. — Besides the external 
bleeding the face and lips of the patient are pale, the 
brow is usually covered with a cold sweat, a rapid 
running- pulse, the face is palid and wears an anxious 
expression. The pupils are dilated. The patient com- 
plains of feeling very faint and weak, and if not con- 
trolled is a reasonable length of time the patient be- 
comes unconscious and may die. The nurse must 
keep cool and not lose her presence of mind as life 
depends upon it. 

Eclampsia. — The next most serious emergency like- 
ly to arise is eclampsia. It is the occurrence of convul- 
sion followed by coma, and like hemorrhage, it is very 
dangerous. It may take place during- pregnancy, labor 
or the puerperium period. The cause of eclampsia is 
not exactly known, but is supposed to be due to the 
improper action of the kidneys ; toxemia or blood in- 
toxication. The cardinal symptoms are uncontrol- 
lable headache, symptoms of imperfect vision, verti- 
go, an unusual desire to go to sleep, eye symptoms, 
flashes of light before the eyes, odema of the face 
and extremities ; disturbance of memory ; anomali- 
ties of the senses ; scanty secretion of urine and the 

148 



presence of albumen and cast in the urine. The pa- 
tient suddenly becomes unconscious and goes into 
a convulsion. The mouth is drawn to the side and 
facial contortions are hidious, and the whole body is 
shaken by a strong- muscular spasm which seldom 
lasts longer than one minute. On awakening from 
an attack the patient complains of headache and 
pains in the muscles. The body is often covered with 
a cold, clammy sweat. During the spasm there is 
great danger of the patient biting her tongue severe- 
ly. To prevent this a firm object should be placed be- 
tween the teeth at the beginning of the spasm. A 
clean clothespin or the handle of a tooth brush is use- 
ful for this purpose. Place the prong end of the 
clothespin or the handle of a tooth brush in the 
mouth between the teeth. Often the patient dies in 
the first attack or convulsion follows convulsion with 
lightning rapidity until death occurs from exhaus- 
tion. The, fetus is usually still born. 

Treatment. — The first thing to do is to send for the 
physician nearest at hand and while awaiting his com- 
ing give a saline laxative. If it is possible, while the 
patient is able to swallow, give a large dose of epsom 
salts, at least one ounce, if it is impossible for the 
patient to take this medicine because she is unable 
to swallow the large dose, give four drops of 
croton oil on a little sugar. This can be 
given even if swallowing is hard. The bowels 
must be made to move freely. A saline enema 
should also be g-iven. The nurse may administer 
ether to counteract the convulsion. 



149 



Chapter X. 

COMPLICATIONS OF THE PUERPERIUM 
PERIOD. 

Sepsis. 

The mother, during the puerperal state, requires the 
most careful nursing. If we study the phenomena of 
labor we will see that it is a process that exposes the 
mother to wounds; that the detachment of the pla- 
centa leaves a raw wound the size of a saucer in the 
uterus. There are denuded places in the birth canal. 
If germs, which cause inflammation, are permitted to 
enter the birth canal they very liable to penetrate the 
raw surface and give rise to inflammation there. This 
constitutes that very dangerous condition known as 
puerperal sepsis. Our knowledge of wounds teach us 
that the mother is a surgical case, exposed to the 
same dangers as any other surgical case, to infection 
or puerperal sepsis. The nurse who sees only hospital 
work is apt to underestimate the danger ; antiseptic 
precautions are less strict in private homes. Sepsis 
may rarely occur even after care. Child-bed fever is 
caused by poisons produced by microbes or germs 
gaining an entrance to the genital tract and infecting 
wounds along the birth canal. The interior of the 
uterus is, after labor, in a condition fit for the recep- 
tion and development of septic germs. Death does 
not represent all the danger or damage that may be 

150 



done. The patient may be sick long after. If we are 
to take proper care of such a case, the patient must 
have the same treatment, the same care, and the same 
surgical cleanliness must be observed that is given 
a patient upon whom a surgical operation has been 
performed. We must apply the principles of asepsis 
during labor and afterwards. And the nurse must 
observe the same aseptic precaution with regard to 
her hands and clothing and any article which she 
may use on or about the patient. Instruments, even 




Fig. 45 — Ignatz Semmelweis, the discoverer of the cause of puer- 
peral infection. 

sterile, may carry infection from without. This may 
be prevented by disinfecting the field of operation. 
Semmelweis, the discoverer of the cause and the in- 
ventor of the means of prevention, in 1847 fi rst 
taught asepsis in labor. Semmelweis, then a young 
interne in the obstetric clinic of the General Hospital 

151 



of Vienna, noticed, with appalling horror, the great 
mortality of the clinic in which he practiced. He 
worked hard and long to rind the cause. He noticed 
that the mortality was greater in the clinic where the 
students and physicians practiced who went from 
post-mortem cases to the confinement room and de- 
livered the expectant mother, than the midwives* 
clinic adjoining. He worked hard and long to solve 
the problem. He argued that the poisons were car- 
ried on the hands of the students and physicians to 
the lying-in woman. He made a rule that hands in- 
serted for examination should be washed in antisep- 
tics. Chlorin water, was the only antiseptic at that 
time. His method saved many lives. The death race 
decreased from fifteen to seven per cent. Nothing 
was known about antiseptics at that time. He 
taught that puerperal fever is caused by the introduc- 
tion of septic material from without. He was ridi- 
culed and abused by the profession, and almost un- 
aided he maintained this position for years, and to 
him belongs the undying credit of having pointed 
out the cause of this awful scourge and the means of 
prevention. He died insane with no other reward 
than the scorn and contempt of his contemporaries, 
but his good work lives and is used with benefit. Pu- 
erperal sepsis is nearly always due to failure to prop- 
erlv cleanse and disinfect the genitals before an ex- 
amination in labor : to making an examination with 
unclean hands : to the use of instruments which have 
not been properly disinfected: failure to keep genitals 
covered with sterile antiseptic dressings after labor : 
changing the dressings without properly cleaning 
and disinfecting the hands, and by there remaining 
in the uterus some pieces of the placenta or mem- 

152 



branes. The occlusion dressing- should be aseptic and 
antiseptic as herein described to prevent and pro- 
tect the wound against infection. If these parts are 
prepared before and during labor, and protected af- 
ter labor as herein described, there is little fear of 
danger of this kind. Doctor C. S. Bacon, of Chicago, 
in a paper read before the Southern Illinois Medical 
Association. November 6. 1902. says. "The mortality 
from puerperal fever can be reduced to almost nothing 
by the proper management of labor and child-birth. 
This has been proven by the results obtained in the 
best maternity hospitals. Mild cases of infection can- 
not be entirely prevented, but they cease to be a 
source of great anxiety to the physician and of danger 
to the mother. In private practice these encouraging- 
results,, due to the aseptic management of labor, are 
not obtained because labor is not managed aseptic- 
ally. In Chicago the mortality from puerperal infec- 
tion has remained about stationary for the last 
ten or twelve years. From live to seven per cent of 
all death oi women of child-bearing age are from puer- 
peral infection. It is probable that the same ratio 
holds all over the state and country. Hence it ap- 
pears that puerperal infection carries off more women 
in the prime of life than any other disease except 
consumption. How much sickness, not fatal, is due 
the same cause can be easily imagined. These 
discouraging conditions are due in part, no doubt, to 
the fact that a considerable number of confinement 
cases are still in charge of incompetent midwives and 
women with no training whatever. So far as the 
responsibility of the profession is concerned the trou- 
ble is that the matter of the aseptic management of 
labor is not taken seriously enough. The frequently 

153 



repeated observation that many women get along 
all right in the worse surroundings seems to create a 
doubt in the minds of many whether all the bother 
required to manage a labor aseptically is necessary. 
The source of all the trouble is, I believe, the failure 
of both the laity and the profession to recognize the 
importance of labor and its management." So the 
nurse will see how necesary it is to use all precaution. 
The treatment lies in the prevention, the source of 
the disease being known it is possible to avoid the 
cause. This lies in absolute surgical cleanliness. 

Puerperal sepsis usually makes its appearance on the 
third or fourth day after delivery. It is commonly 
ushered in by a chill, followed by a high fever, the 
temperature rising as high as a hundred and three to 
a hundred and five degrees F. The pulse is rapid and 
running with an anxious expression of countenance. 
The patient is restless and uneasy. The lochia dis- 
charge is altered and suppressed. But it must be re- 
membered that because the obstetrical patient has 
fever it must not necessarily be septic ; it may be 
caused by the condition of her breast or bowels and 
many other causes, but, of course, the first thought 
that presents itself to us is that it is sepsis. 

This infection may be general or local. The later 
is confined to the vulva, vagina and uterus and is less 
serious. The former affects the whole system and is 
usually fatal. 

THE BREAST. 

Engorgment of the Breast. — This is the most com- 
mon complication affecting the breast, and at the 
same time a very painful complication. The breasts 
becomes very much engorged and are heavy and hot 
and very painful. 

154 




Fig-. 46 — Breast bandage applied. 



Treatment. — The usual treatment is to apply the 
breast binder tightly and regulate the flow of milk in 




Fig. 47 — Breast bandage showing how to cut a jacket bandage from 
a straight piece. 



this way. Some physicians order, if the case is severe, 
hot compresses, others ice bags. I have always found, 

155 



by paying close attention to them on the third and 
fourth days; massaging them gently if they seem 
over-distended, and then controlling the flow by ap- 
plying a breast bandage, the glands will secrete 
evenly and this painful condition is prevented. 

Fissures and Cracks of the Nipple. — These are 
very important because they render nursing difficult 
and sometimes impossible. The nipple should be 
washed with boric acid before each nursing, and after 
baby lias finished nursing the nipple should be 
washed off with a little witch hazel. If small or 
sunken, they should be pulled out with thumb 
and index finger and much trouble may be 
saved by putting the infant to the breast and teach- 
ing it how to take hold before they become engorged. 
If the patient complains of soreness or a tenderness 
when baby takes hold of it, the nurse should examine 
them carefully, and special care given them. They 
should be cleansed carefully after each nursing, and 
a nipple shield made of a glass bulb and a soft rubber 
nipple should be used to save the mother as much 
pain as possible. The nipple and shield is cleansed 
thoroughly after each nursing and kept in a five per 
cent boric acid solution, and both nipple and shield 
should be boiled once a day. The nurse should re- 
port to the physician as soon as she detects a crack 
in the nipple and get extract instructions from him in 
regard to treatment. 

Mastitis. — Mastitis or inflamation of the breast is of 
microbic origin, and are of three kinds. Those in the 
eranular tissue itself called the parenchvmatous ; sec- 
ond, those in the connective tissue, just beneath the 
skin, called the subcutaneous ; and thirdly, those in the 
deep connective tissue beneath the gland, called the 

156 



postmammary. This last is very serious and rare. They 
are caused by cracks or fissures upon the nipple. 
Germs, which are of microbic origin, get in and fol- 
low the milk glands. This causes inflammation, con- 
gestion of the parts and finally superation. 

Symptoms. — Pain in the affected breast, and par- 
ticularly in one place. The part is inflamed and swol- 
len ; is hot and sensitive. As soon as the nurse de- 
tects any sensitiveness or redness of the breast she 
should inform the physician at once, and support the 
weight of the breast with a bandage. 

Puerperal Insanity. — This condition is not often 
met with in obstetrical nursing, and when it does oc- 
cur, it is very sad. Melancholia and mania are both 
present. Suicidal tendencies are strong, also, often 
the desire to kill the child. 

Symptoms. — The symptoms are the loss of love for 
the child ; the mother will not have it near her, she 
seems to hate the infant and will not nurse it and the 
sight of the child seems to excite her. She is restless 
and does not sleep well ; has delusions of sight and 
hearing and indistinctiveness of speech. In nursing 
such a patient the nurse must use great watchfulness 
that the patient does not destroy herself or child. 
She must not be left alone a single instant, two nurs- 
es are absolutely necessary. The room in which the 
patient lives should be arranged and furnished to pre- 
vent her jumping out of the window, and only the 
absolute furniture necessary in the room, in fact the 
general rules for the nursing and care of the in- 
sane are applicable here. The patient's nutrition must 
be kept up, like insane persons the patient may refuse 
food and have to be fed with the stomach tube. There 

157 



is no other condition in which a conscientious trained 
nurse can be so valuable. Use great tact and kind- 
ness and try and win the confidence of the patient. 
Never use force, except when it is a question of life, it 
only excites the patient and nothing is gained. Re- 
covery is rather slow. 

Paralysis. — Paralysis following labor is due to in- 
jury to the pelvic nerves, caused usually by pressure 
of the presenting part pressing on them, or the instru- 
ments, or failure to use forceps at the proper time. 
thus allowing the pelvic nerves to be injured by con- 
tinued pressure. 

Septic Phlebitis. — Septic phlebitis or milk leg as it 
is commonly called by the laity, is caused either by 
obstruction of the femoral vein by a blood clot or an 
infection of the vein and cellular tissue. The former 
generally results from cold or overexertion, the lat- 
ter explains itself. The patient may first complain of 
pain in the neighborhood of the groin, the leg swells 
and becomes very painful, white and tense. It is usu- 
ally accompanied by a fever and often a chill. 

Treatment. — The treatment is absolute rest, support 
the limb, do not let the bed clothes rest upon the foot 
Nothing must touch the limb, and keep it warm by 
wrapping it in cotton or flannel. Massage or rubbing is 
very dangerous. The immediate danger lies in the fact 
that a portion of the blood clot becoming broken off 
may be carried by the circulation and lodged in one 
of the vessels of the heart or lungs with fatal termi- 
nation. The conditions gradually subside, but some- 
times Aveeks elapse before convalescence is complete. 
Often there is a formation of serum or pus. This 
must be opened and drained. 

158 



Subinvolution. — Subinvolution is the arrest, or hin- 
dered, or incomplete return of the uterus to the nor- 
mal size and condition after labor and child-birth, 
and gives rise later to much discomfort. It is due 
generally to severe lacerations of the cervix or a lack 
of tone in the uterine muscles, or the presence of large 
blood clots in the cavity of the uterus. A failure to 
nurse the child may predispose to subinvolution. The 
treatment lies in the removal of the cause which is 
the physician's duty. 



i5y 



CHAPTER XI. 

POINTS OF SPECIAL INTEREST DURING 
PUERPERIUM. 

Sleep. 

The nurse should insist on the family keeping out 
of the lying-in chamber. It is so strange, women 
who have been mothers themselves, who one would 
expect should know the importance and necessity of 
quiet sleep, and rest after labor, should be so thought- 
less, they call and almost insist on seeing the patient. 
No one should be allowed in the room immediately 
after labor except the father of the child. Keep the 
mother quiet. The patient, after she is dressed and 
toilet over should be encouraged to go to sleep. The 
exertion of labor is usually followed by a feeling of 
comfort and repose. The patient is often inclined to 
talk. This should not be allowed, but the patient 
encouraged to go to sleep. 

Chill After Labor. — The birth of the child is often 
followed by a nervous chill or rigor, which is usually 
of short duration and seldom lasts over ten minutes, 
it is of little importance and is caused by the shock of 
the sudden expulsion of the uterine contents and the 
great muscular effort the patient has been through. 
It is usually relieved by applying hot water bottles and 
Joeing warmly covered after which the patient usually, 

160 



when encouraged, falls into a refreshing, restful sleep. 
It is never accompanied by a rise of temperature. 

The Pulse. — The pulse exhibits a remarkable 
diminution in frequency, lower than her ordinary 
normal pulse. In perfect normal cases it ranges from 
50 to 70 beats per minute. Usually more marked on 
this third day. It is not influenced by the establish- 
ment of lactation. 

The Temperature. — The temperature is about the 
same as in health, although a rise of a half of a degree 
to a degree and a half is not unusual on the third 
day, caused by the disturbance attended upon the 
establishment of lactation. 

The Abdomen. — The abdomen is tender under pres* 
sure, but this should diminish daily and after a few 
days disappear. It is caused by severe labor, or a 
great deal of manipulation during labor. Ice bags 
applied to the abdomen will prevent and correct this 
condition. 

The Uterus. — The uterine contractions should be 
firm and persistent. At the close of labor the fundus 
is midway between the umbilicus and pubes, and by 
the ninth day it should be behind the pubes. Watch 
the bowels and bladder and see that they do not be- 
come full and cause misplacement. 

The Appetite. — The appetite is diminished and 
thirst increased. 

The Skin. — The skin is active and the patient sweats 
freely and is consequently susceptible to changes. The 
nurse must be careful of draughts. 

The Bladder and Bowels. — The bowels are usually 
sluggish and the urine abundant. The first two or 

[in 161 



three days following confinement the retention of 
urine is common. Many women who are unable to 
urinate when reclining- can do so when raised to a 
sitting position. 

The Lochia. — The discharge from the birth canal 
after delivery is termed lochia. At first the normal flow 
is composed of pure blood with clots and shreds of 
membrane, but after the first day it contains a large 
per cent of serum. About the fourth day the dis- 
charge is quite pale and it continues to lose its red 
color, and about the eight day it is a greyish-cream 
color, and of the creamy consistency. Microscopically 
after the third day the lochia contains red and white 
blood corpuscles, shreds of cast-oil membrane which 
contain hundreds of germs. The germs are harmless,. 
not perulent. unless the patient is septic. It gradually 
diminishes in quantity from the close of labor. The 
duration is from three to six weeks. It varies in 
different women, usually according to the menstrual 
flow. Those who menstruate freely, generally have 
a profuse discharge after birth, those women whose 
menstral flow is scant, the lochia discharge will not 
be so abundant. After the patient is allowed to sit up. 
fresh red blood often makes its appearance. It should 
never have a fetid odor. Watch the discharge for 
any unnatural odor and save a pad each morning 
for the doctor's inspection. Xote the character and 
amount of the lochia, clots and membrane expelled, 
also the position of the uterus on the record sheet, note, 
also, anything abnormal and save same for the doctor's 
inspection. Be very careful of all vaginal discharges. 
It is never to be gotten into abrasions of the skin or 
the eves. If gotten into the eyes it will often produce 
blindness, and if gotten into abrasions of the skin it 

162 



may carry with it septic germs. The nurse must be 
very careful of her hands. Be careful to cleanse them 
thoroughly after each manipulation around the geni- 
tals before touching or handling the breast as it is 
possible to earn- infection to them in this manner. 
Xurses may carry infection on their fingers from 
the lochia of a perfectly normal puerperal and infect 
the mother's breast and the infant's eyes if care is not 
exercised to keep the hands clean. When the dis- 
charge is infectious and there is a suspicion of gonor- 
rhea or syphilis rubber gloves should always be worn 
as a personal safety. 

The Breast. — The breasts are distended and on the 
third day of the lying-in period the milk appears. The 
breasts then become full, hard and tense, and are very 
painful. The auxiliary glands enlarge and radiating 
pains are felt in the arms and breast. It often causes 
considerable disturbance and is sometimes ushered 
in with a chill and rise of temperature. Treatment 
has already been described. 

Lacerations. — Lacerations of the perineum are very 
common, but they differ much in extent from a mere 
skin tear to one requiring sutures, internal as well as 
external. The treatment the same as other surgical 
cases, observing strict surgical cleanliness in regard to 
the dressing, keeping the wound clean by washing and 
irrigating with antiseptic washes, keeping the parts 
dry and covered with proper antiseptic powders, 
such as boric acid or arristol and sterilized gauze or 
dressings each side of the sutures, and being careful 
that all instruments used on the patient and the 
hands of the nurse are surgically clean. With care 
and treatment of this kind the wound usually heals 
nicely. 

163 



Chills. — A chill with a high temperature is evidence 
of serious illness, very often sepsis. A chill with no 
temperature has no important significance. 

The Record of the Nurse. — The nurse should keep a 
daily record or history of the cases of both mother 
and child until the case is discharged. Keep it neatly 
and accurately filled up to the date and hour, always 
ready for the doctor's inspection. If the case is a per- 
fectly normal one, he may not pay much attention to 
the record, just glance over it; but if any complica- 
tions present themselves he will feel very grateful 
to find an accurate historv of the case. 



164 



CHAPTER XII. 

OBSTETRICAL OPERATIONS. 

Frequently in the course of labor difficulties pre- 
sent themselves which, in order to save the mother 
and child, an operation becomes necessary. The gen- 
eral rules for surgical nursing apply in obstetrical 
nursing. The same surgical care and cleanliness 
must be observed in the care of an obstetrical patient 
as one upon whom a surgical operation has been per- 
formed. No surgical patient is more susceptible to 
infection than a lying-in woman. If during the 
course of labor the possibility of an operation is con- 
sidered, the nurse should make the necesary prepara- 
tions according to the nature or extent of the opera- 
tion. A kitchen table makes an excellent operating 
table, this is covered with a blanket, to make it soft, 
and over this is placed a labor pad made of old news- 
papers and sheet as already described. Any small 
table, sewing table or similar one, makes an excellent 
one to hold the instruments and solutions. Or a 
table may be made by placing a table-leaf or ironing 
board across two chairs, and these do very nicely to 
hold the instruments and solutions. But in nearly 
every home there are small tables that may be used 
as side tables, these should be covered with news- 
papers to protect them during the operation. If the 
physician has a Kelly pad with him it should be 

165 



sterilized by boiling' twenty minutes in plain water, if 
he has none, the nurse may substitute one of news- 
papers by making a roll of newspapers, shaped like a 
Kelly's pad, covered with a rubber sheet or if 
there is no rubber sheet obtainable, a piece of 
oil cloth or a clean sheet may be used. When the 
patient is placed on it that part immediately 
under the buttocks, must be covered by towels that 
have been boiled in a one to two thousand 
bichloride solution. If a rug' is in the room, it 
should be removed ; the floor should be protected by 
spreading old newspapers around. The room should 
be warm as the patient is exposed a great deal and 
there is danger of her taking cold. The best light ob- 
tainable must be had, and the table must be so placed 
that the light enters the vagina. If the operation 
takes place during the day, the table must be placed 
facing the best window, and if at night near the 
center of the best light obtainable. A chair should 
be placed in front of the table so the operator may 
sit down if he desires to. The surgeon, of course, 
furnishes the instruments needed in each particular 
case, but the nurse should know the instruments in 
common use by sight and name so as to be of the 
greatest assistance possible to the surgeon and be 
able to hand him the instruments he may ask for. 

Perineorrhaphy. — This is the most common opera- 
tion. It is the repair of the perineum. The damage 
to the perineum may differ from a mere skin tear to 
one requiring sutures internal as well as external. 
For this operation the patient is placed across the 
bed in the lithotomy position. An anesthetic is not 
given as it predisposes to hemorrhage, and the wo- 
man is usually able to stand the pain, as the parts are 

166 



benumbed by the stretching caused by the child's 
head or presenting part pressing on the part, and 




Fig. 48. — Lithotomy Position With Liml 
by a Sling- Sheet. 



supported 



usually the patient still feels the effect of the anes- 
thetic given her during the birth of the child's head. 
When the operation is over, the patient's toilet is 
completed and she is laid on her back in bed. and 
special care must be used in moving the patient so 
as not to pull on the sutures, and she should keep her 
legs still and not move them as the union is delayed 
by so doing. 

Forceps Operation. — This is a very frequent and 
often a hard operation. "When the mother's labor is 
long, hard and tedious, and do her best, she cannot 
bring the head or presenting part through the pelvic 
opening, the physician assists her by the use of for- 
ceps. Forceps should never be used unless it is im- 

ssible for the mother to give birth to the child, or 
there is danger for one or both if birth is not has- 
tened. Unless forceps are used at the proper time, 
and are properly applied and manipulated, they may 



167 



do the mother great injury, and the child be perma- 
nently disfigured. If it is necessary to use the for- 
ceps, the patient should be cleaned. The perenium, 
vulva and adjacent parts washed with a one to two 
thousand bichloride of mercury solution, a large 
bichloride pad in the strength of one in five thousand 
is placed over the birth canal. All bloody and soiled 
cloths should be removed and the patient placed 
across the bed with hips close to the edge, the knees 
far apart and flexed on the abdomen. The sling sheet 
is best. It is placed under the knees and tied back of 
the neck over the shoulders. This is called the 
lithotomy position. The legs are covered by wrapping 
a sheet around them, or the long leggins that are used 
for this purpose are worn. The two foregoing opera- 
tions are what we might term the "Minor Operations 
of Obstetric." While they require skill and careful 
surgical nursing, they are not so serious as some of 
the others, and fatalilties are almost unknown. Under 
the term "Major Obstetric Operation," there are sev- 
eral. The most frequent ones are Version and Ces- 
arean Section. 

Version. — Version means the turning of the child 
from an unfavorable to a favorable position; as an 
arm presentation to feet presentation. The opera- 
tion is often difficult and hard. If the labor in which 
a child presents transversely, as in arm or shoulder 
presentation, is neglected, the child may be wedged 
in so tight that it cannot be turned so it can be de- 
livered, and the only way to save it would be an ab- 
dominal section, "Cesarean Operation." In this opera- 
tion the uterus is sometimes ruptured in the effort 
to save the child. This is a sad accident for both 
mother and baby. The fatalities being about sixty 

168 



per cent for the mother and ninety-eight per cent for 
the child. The child is sometimes lost by the prema- 
ture detachment of the Placenta. Position of patient 
the same as for forcep operation. 

Cesarean Section. — The Cesarean section operation 
has succeeded the operation known as Craniotomy, 
This was a horrible mutilating operation on the 
fetus. The skull of the child was opened with long- 
sharp scissors, the brain matter extracted, and the in- 
fant's head crushed to reduce the size of the head, 
and the child was extracted after this process. It 
was a horrible thing to contemplate, the sacrifice of 
the child to save the mother. But surgical science 
has advanced so that this awful operation is almost a 
thing of the past, and with the operation known as 
"Cesarean Section," the lives of both mother and 
child may be saved. The operation is performed 
when the baby is too large, or the passage too small 
to allow a natural delivery, or when the maternal pas- 
sages are obstructed by deformity or the presence of 
a turner or growth and there is not room enough for 
the passage of a living child. The surgeon make an 
abdominal incision and delivers the child in this man- 
ner. It is not as serious an operation as is supposed. 
Mortalities, under good conditions, being about eight 
per cent. Such a patient should be removed to a 
good hospital if condition permit. Preparation for 
the operation the same as those for Lapraotomy. If 
the patient is operated on at home, great care must 
be exercised to have everything as asceptic as pos- 
sible. The preparation of the patient the same as any 
Lapraotomy patient. 



169 



CHAPTER XIII. 

THE CARE OF THE BABY. 

"The hand that rocks the cradle 
Is the hand that moves the world." 

Upon the health and welfare of the human race de- 
pends on the care and dealing of childern. It. begins 
with the infant in the cradle, that little tiny spark of 
humanity, and no time from the cradle to the grave, 
is so important as infancy. No other little animal 
comes into the world as helpless and remains in a 
dependent condition as long as a baby. This help- 
lessness renders it particularly liable to disease. So 
that infancy is a period of special danger. It is our 
duty, as nurses, to guard and protect this spark of 
life, and by our skill and care try and comfort the 
mother who has just passed through one of the most 
trying ordeals. The care of the infant begins with 
its separation from the mother, the severing of 
the umbilicus cord, its existence independent and 
separate from the mother's is then established. 

The first thing to do for a baby as it is ushered into 
the world is to see that the mucus is removed from the 
mouth and throat of the infant so when it cries and 
breathes, nothing can be drawn into the lungs. Next 
see that the eyes are washed free from all secretions. 
A saturated solution of boric acid and little cotton balls 
should have been previously prepared for this pur- 

170 



pose. This is the physician's duty, but you will 
sometimes find he will depute the nurse, and she 
should know how to do it, and do it well. Some- 
times it is neglected and the responsibility devolves 
on the nurse. Be sure they are clean. Many children 
in the blind asylums are there from neglect of this 
kind. The physician usually takes the advantage of 
a short rest the mother has after the birth of the 
head to wash the infant's eyes, and the nurse should 
anticipate his wants and be ready to hand him what 
is needed. At this pause, hand him the solution, 
which should have been poured into a clean cup, and 
the little cotton balls, which should have been made 
and placed in a clean saucer, for washing the infant's 
eyes. And with a large pad of absorbent cotton wet 
with the boric solution, wipe the secretion off of 
baby's face. The nurse should, however, be very 
careful and not assume any of the responsibilities 
that belong- to the physician. Should you be alone 
and the physician not arrive in time, see chapter on 
"Delivery of the child in the absence of the physician" 
elsewhere in this book. 

As soon as the child is born it is covered by a warm 
towel, and laid a short distance from the mother on 
its right side. The nurse should see that it does not 
pull on the cord or the mother lie on it, or hurt it 
with her feet or legs. It will gasp or sneeze, this 
clears the air passages. Then rather a short cry, and 
then it cries lustily, this expands the lungs, and in- 
dependant circulation is then established. 

The next thing is to be sure the baby is breathing 
properly. The circulation of an unborn child differs 
from that of a child after birth. The child in the 
uterus lives through the oxygen obtained from the 

171 



blood of the mother. Thus the child has no need to 
breathe. The blood of the child passing through the 
umbilicus cord into the placenta comes so close in 
contact with the mother's blood that sufficient oxy- 
gen passes from the mother to the child for its needs. 
For these reasons the lungs are empty and require 
very little blood before birth, and as the cord is really 
the lungs or breathing apparatus of the child we will 
see how necessary it is, how important, and why the 
medical faculty lay so much stress on not cutting 
this cord until the child cries vigorously. The pulsa- 
tion first stops in that part of the cord next to the 
placenta. The lungs of the infant are empty until it 
draws its first independent breath. With the first in- 
spiration the thorax expands, the air fills the alveoli of 
the lungs, at the same time the blood passes from the 
right side of the heart to the lungs and is returned aer- 
ated and purified to the left side of the heart. To cut 
this cord before the child's lungs are expanded, would 
be to asphyxiate the baby. Because as soon as the cord 
is tied and cut it ceases to obtain oxygen from the 
mother. Before birth there is an opening between 
the two sides of the heart, the foramen ovale, and 
as the blood is not needed in the lungs nature has pro- 
vided other means by which the blood is aerated and 
purified. Through the umbilicus cord. It passes 
from the right side of the foetal heart into the left side 
instead of going from the right side of the heart to the 
lungs. At the establishment of pulmonary circulation, 
the lungs unfold, the ductus arterious contracts, the 
foramen oval closes. For these reasons and to assist 
nature in her work the baby should be laid on its 
right side for the first eight or ten days. If this open- 
ing does not completely close the venus and arterial 

172 



blood mixes, and if the lungs are not expanded fully, 
the blood is not properly oxygenated and we have 
that condition known as a "Blue Baby/" and if this 
condition is very marked, as a rule, the child does 
not live long, but dies in the course of twenty-four 
hours. After the cord is severed it is protected bv 
a large piece of sterilized cotton wrung out of a one 
in two thousand bichloride of mercury solution and 
wrapped around it. The child is then annointed well 
with olive oil. The oil should be rubbed ivell into 
the hair, armpits, groin, and wherever the vernix 
caseosa is abundant. This aids greatly in its re- 
moval. After the baby is oiled it is wrapped again 
in its little blanket and put in a warm place until the 
nurse is ready to Avash it. The longer the oil is 
allowed to remain on, the easier it is to wash the 
vernix caseosa off. A strong full term baby may be 
washed anytime from a half an hour to several hours 
after birth. It is usually washed at the convenience 
of the nurse, while the mother is asleep or resting. Be 
sure its little face is not covered. A baby needs all 
the fresh, pure air possible for the expansion of its 
lungs. Examine the child carefully for any possible 
defects. Before taking the baby up to wash it, the 
nurse should be sure she has everything at hand . 

The Articles Necessary for Baby's Bath. — Large 

soft bath tOAA'el to wrap the baby in during its bath, 
two soft silk sponges or linen wash cloth^. one for the 
face and larger one for the body, a bath tub or large 
wash bowl to bathe the baby in, a small clothes 
horse, towel rack or chair to hang baby's cloths over 
that they may be aired and warmed near the heat 
while the bath is given, a low rocking chair without 
arms, a low table or stool for the basin or tub to 

173 



rest on at a convenient height. Boric acid solution 
for the eyes and mouth, little cotton balls to wipe 
the eyes and small pieces of cotton or old linen for 
the mouth. Boric acid powder for dressing the 
umbilicus and baby's toilet articles such as soap, comb, 
brush, pins, soft old towels and water the proper 
temperature. 

Temperature of the Room. — The temperature of 
the room should be about 72 degrees F. The bath 
should be given near the open fire or heater of some 
kind and where there is no exposure to draughts. 

Temperature of the Bath. — All babies at first need 
a great deal of warmth, and a new-born baby pos- 
sesses feeble power of resistance to cold. The bath 
the first month should be at a temperature of one 
hundred, Fahrenheit. After the first month until six 
months the temperature of baby's bath should be 
ninety-eight. Always test the temperature of the 
water with a thermometer; never attempt to guess 
at the temperature by placing your hand or elbow 
in the water. A nice bath thermometer, one that is 
small and convenient, is a floating dairy thermometer 
In case of a weak, delicate baby, it is best not to wash 
it until the next day. In such a case oil the baby 
and wipe the vernix caseosa off with absorbent cot- 
ton. Wash its little face and hands, apply the dress- 
ing to the umbilicus and postpone the general bath 
until the next day. A tub or plunge bath is never 
p-iven an infant until the umbilicus cord has come 
off, which usually occurs within from five to ten 
days after birth. It should not be given sooner than 
one hour after feeding, in warm room, and if possi- 
ble in cold weather, before an open fire. After the 
first bath, the best time for bathing the baby is in 

174 



the morning, midway between feedings. The baby 
should never be bathed while it is perspiring freely, 
and be careful of draughts. If baby seems exhausted 
and the skin bluish after its bath, the bath should be 
omitted and the baby sponged oft". 

How to Bathe the Baby. — First wash the eyes with 
saturated solution of boric acid, wash and flush them 
well. Wipe them dry with the little cotton balls 
made of dry sterilized absorbent cotton. Xext the 
mouth is washed with the same solution. AYrap 
absorbent cotton or a piece of old clean linen or gauze 
around the index finger of the right hand, saturate 
the cotton or gauze with the boric acid solution and 
gently wash the tongue, roof and between cheeks 
and gums. Then next the nose is cleansed by insert- 
ing cotton wet and rolled small enough so it enters 
the nostrils without difficulty. This causes a tickle- 
ing sensation, which will cause the infant to sneeze. 
The sneezing clears the air passages. The little face 
is then washed and dried, using no soap on the face. 
The clothes are then removed, with the exception of 
the napkin, and the little body is wrapped in a soft 
old woolen blanket or a large soft bath towel. The 
head is then soaped well with castile soap. The little 
head is then held over the bowl, the entire body 
supported and resting on the left arm of the nurse, 
while the head rests in the nurse's left hand. She 
thoroughly rinses the soap oft with the use of the 
rig-lit hand, after which the little head is drved well. 
The bodv is then washed with a soapy sponge, 
particular attention being given to those parts which 
come in contact, and in the folds of the skin, especially 
the buttocks. Very little soap is used on a baby, the 
buttocks being the only part requiring soap. The 

175 



first ten days or until the cord comes off, the baby 
is washed in sections on the nurse's lap, drying and 
covering one part before commencing another. After 
the cord is off baby is washed as described, then the 
little body and buttocks are washed with a soapy 
sponge and the baby is then lowered slowly and gent- 
lv in the bath tub or bowl, with its little body well 




Fig. 49 — Arrangements for bathing an infant. 

supported by the hands and arms of the nurse. To 
prevent shock the baby should have a small towel 
wrapped around it before immerging it, and to pre- 
vent the infant sliding from side to side a small 
towel or one of baby's napkins is placed in the bottom 
of the tub for baby to rest upon. The baby is rinsed 
off quickly and taken out and dryed with a soft 
towel by gently patting, not rubbing, and particular 

176 



attention being paid to the groin, under the arms, 
the folds in the neck, ears and behind them, the 
palms of the hands and between the fingers and toes. 
As a rule the infant should be bathed every day, 
unless a delicate baby, and everything prepared be- 
fore it is undressed. The bath given quickly in a 
warm room. The infant should not remain in the 
bath longer than two minutes. 

Care of the Eyes. — The eyes should be carefully 
washed night and morning, a solution of boric acid, 
ten grains of boric acid crystals to the ounce of water, 
and little soft cotton balls. If any pus appears they 
should be cleansed every hour, using for this purpose 
a soft rubber ear syring. Hold the eye open and ir- 
rigate thoroughly. Never allow it to harden or form 
a crust on the eye-lids. It is harder to remove and 
will cause them to become sore and irritated. Should 
any pus appear the attending physician should be 
notified at once. Do not expose the eyes of an infant 
to strong light. Always turn the face away from the 
sun and wind. Until the baby is three weeks old, it 
should be kept in a moderately darkened room. 

Care of the Mouth. — The mouth should be cleansed 
before each feeding and after baby's feeding, if the 
baby does not go to sleep. Usually a child falls to 
sleep after nursing and then it should not be dis- 
turbed. The mouth is washed by wrapping a piece 
of old clean cloth or absorbent cotton around the in- 
dex finger of the right hand, saturate it with boric 
solution, which is the solution an infant's mouth is 
washed with. Cleanse the folds between the gums, 
lips, cheeks, roof and tongue. Be very careful and 
gentle, as the. mucus membrane is very delicate 



[12] 



177 



If this is carefully attended to, we will never have 
that condition known as "thrush." 

Care of the Skin. — The skin of a baby should feel 
warm, soft and velvety. It is very delicate and little 
if any soap should be used, and then only pure 
castile soap. And when soap is used be very careful 
to rinse it off well. And in drying the skin never 
wipe or rub it. This irritates it. Dry the skin by 
softly patting it with an old towel. Avoid dusting 
powders., use them sparingly if at all, especially with 
a fat infant ; it gets into folds of the skin, under 
the arms, in the groin and when baby perspires 
forms a paste which is very irritating. Dusting 
powders do more harm than good unless they are 
properly used. When they are used the superfluous 
powder should be brushed off with a soft camel hair 
brush, such as is used as a hair brush for babies. 
Generally if the baby is carefully washed and dryed, 
their use will not be necessary. Should the skin 
be very sensitive or the baby chafe, discontinue all 
soap and substitute the bran bath, which is made by 
putting enough bran in a coarse cloth or bag, place 
it in the bath water and squeeze it until the water is 
thickened. In severe cases the bran bath should be 
omitted and the body kept clean by mopping it with 
absorbent cotton and olive oil. The most common 
place for baby chafing is the buttocks. As these 
parts are so often wet and soiled, great care must 
be taken to avoid this painful condition. Remove the 
napkin as soon as it is wet or soiled, and bathe the 
parts well. Apply plain zinc salve or mutton tallow 
in which a little gum camphor is dissolved, liberally, 
and for heat on baby's body, sponge the parts with 
equal parts of vinegar and water. After its morning 

178 



bath each morning, baby is rubbed well with olive 
oil. This keeps the skin in good condition. 

Care of the Cord. — Wrap the stump of the umbilicus 
cord with aseptic absorbent cotton, wet with a one 
in two thousands bichloride solution and lay to the 
left side immediately after birth. If the cord is not 
left long enough to fold over to the left side, it is 
very difficult to dress it, as it should be, and often 
produces a "pouting" navel and may result in 
umbilicus hernia. After baby's bath wash the 
adjacent skin with a one in two thousand bichloride 
solution, and wrap a piece of sterilized gauze over 
the hrst dressing of bichloride cotton. Then dust 
boric acid powder freely underneath and around the 
cord. Boric acid is a mild antiseptic and drying 
powder and should be used freely all around the cord 
to hasten drying. Each day when baby is bathed, 
cleanse the vicinity of the navel with bichloride solu- 
tion in the strength of one in four thousands and 
sterilized absorbent cotton, and then dust the boric 
acid powder freely around the cord. Be very careful 
and do not wet the stump of the navel cord, and the 
first dressing that is applied should never be dis- 
turbed as long as it remains dry. It usually remains 
adherent and comes away with the cord. The stump 
of the cord in a few days shrivels up to a thin, tough, 
dry strand. At the edge of the skin where the cord 
is inserted, a line of granulations form which separates 
the stump. The falling off of the cord should be 
noted, and the antiseptic treatment of the wound con- 
tinued until it heals over. The navel is kept surgic- 
allv clean. The nurse's hands should be cleaned 
and disinfected before handling it. The cord and 
navel are surgical wounds subject to infection, and 

179 



the same aseptic precaution must be taken and ob- 
served in dressing and handling it as any other sur- 
gical case. Many infants die from infection which 
usually results in tetanus. In many cases it is the re- 
sult of negligence in not observing surgical cleanli- 
ness in handling and dressing it. Should a fetid 
odor develop, notify the physician. Never put vas- 
eline or any kind of grease or oil on the umbilicus 
cord. The cord must dry up, and if we put grease 
on it, it will decompose and may cause serious 
trouble. Watch the cord carefully for several hours 
after birth to see that there is no bleeding. There 
have been cases where babies have become very weak 
from loss of blood before this condition has been dis- 
covered. Should hemorrhage occur, apply a paii 
of artery forceps, or have some one squeeze the cord 
tightlv outside the dressings. But under no circum- 
stances touch the cord with the ringers. Disinfect 
vour hands and tie the cord again with a piece of 
sterile tape. Tie just above the first ligature. Xow 
wash the cord and adjacent parts with a one in two 
thousands bichloride solution, put on a fresh piece 
of sterilized absorbent cotton saturated with a one 
in two thousand- bichloride solution, and over this 
vour sterile gauze. Then dust freely, as before. 
with boric acid powder and apply the binder. If 
umbilicus hernia should occur, it is usually caused by 
partial failure in the development of the abdominal 
wall in early fetal life, or to crying or stress against, 
this defective wall. Should it occur, a compress must 
be used. Cover a twenty-five cent piece, after it has 
been sterilized by boiling, or a thin piece of cork- 
about the same size and thickness, with several layers 
of old clean linen or gauze, place it against the cord. 

180 



a thin layer of aseptic cotton between; now apply 
surgical adhesive plaster across it in small strips,, 
interlacing and crossing each other. This often cor- 
rects this condition. Care must be taken to keep the 
umbilicus clean. The compress should be removed 
every three or four days and the cord cleaned with 
cotton and bichloride solution, then dust a little boric 
acid powder around the cord and reapply your com- 
press. In applying the adhesive plaster, try and 
apply the strips in different places so as not to 
cause an irritation of the skin. This is often all the 
treatment that is necessary. 

Care of the Genitals. — Perfect cleanliness is abso- 
solutely essential. Xo secretions should be allowed 
to accumulate. The parts should be washed daily, 
usually at the time of the bath. These parts should 
receive special attention at birth. Male babies, the 
prepuce or foreskin should be pushed well back and 
with a little sterile olive oil and cotton all secretion 
should be wiped from the gland. The penis is then 
wiped off with a saturated solution of boric acid or 
a mild bichloride solution in the strength of one in 
ten thousands, and the prepuce gently smoothed back 
in place over the penis. Little girl babies are by far 
the most difficult to wash. The mucus membrane 
of the labia is so delicate that the greatest care must 
be exercised not to irritate it. and as a rule the labia, 
vulva and adjacent parts are covered very thickly with 
vernix caseosa. The free use of sterile olive oil aids 
greatly in its removal, allowing it to remain on for 
some time before removing it. Then with cotton 
remove it very gently. Sometimes it requires seA'eral 
applications before it is clean. Never rub or use 
force. Great care must be used not to injure the 

181 



delicate external genitals in the removing- of the 
secretion which sometimes accumulates in the little 
labia folds. To anything abnormal the physician's 

attention should be called at once. 

Care of the Nails. — The nails of a baby are best 
cleaned with a toothpick. A small piece of absorbent 
cotton is wrapped around the point so as not to in- 
jure the delicate, tender skin. Cut the finger nails 
round and the toe nails square, to prevent ingrowing 
toe nails. 

The Clothing.— In winter the body should be 
covered by a soft flannel shirt, and in summer a thin 
gauze flannel or silk shirt is worn. The abdomen 
and umbilicus is supported and protected by a flannel 
band which should fit snug, but not too tight, but be 
firm enough to give support to the abdominal wall. 
In the contraction of the limbs in temper a great 
deal of force is sent to the abdominal wall. If the 
binder is on properly there is little danger of umbilicus 
hernia. The abdominal binder or belly band of a 
baby should go once and a half around the body ; it 
should fit snugly, but not too tight, as it would inter- 
fere with the free movement of the chest in breathing, 
and sometimes, if too tight, it presses on the stomach 
and causes the infant to vomit its food. If too loose, 
it will slip up and thus fail in the use or purpose for 
which it was intended, namely, to keep the vital 
organs warm, to keep in place the umbilicus dressing, 
and the most important, to support the abdominal 
wall. The band should be discarded when the child 
is about three months old and replaced or succeeded 
by the flannel knit ribbed abdominal binder with 
shoulder straps. This style should be worn summer 
and winter until the child is eight years old. Espe- 

182 



cially is it recommended for little boys. There are two 
grades, winter and summer weight. They are a great 
protection, especially for delicate children. Keep the 
baby's feet warm, but avoid wrapping it in shawls 
until it is covered with perspiration. The room should 
be kept the proper temperature and wraps will not 
be needed. 

How to Dress the Baby. — The child lies on the 
nurse's lap. The flannel band is first applied. This 
should go once and a half around the infant's body. 
Be firm but not tighter than will permit the introduc- 
tion of three fingers. It is pinned on the inner left 
side three times, at the top, center and bottom, or outer 
edge. In pinning it thus, the pins are neither direct 
on the left side or abdomen, so the child will not lie 
on it and hurt it. A condition which if it exists is 
often responsible for a cross baby. Then the little 
shirt is put on. This should have long sleeves and 
open all the way down the front, and it should be 
pinned to the diaper in front and in the back, to keep 
the little shirt from ridding up and the napkin from 
slipping down; then the little flannel skirt, petticoat 
and dress are put on in order. Always put an in- 
fant's clothes on over its feet and not over its head, 
and the infant should lie in the lap of the nurse. It is 
very awkward to see a nurse trying to dress a baby 
holding it in a sitting position, putting its clothes on 
over its head. Don't do it. And to avoid lifting it 
so often, fit the skirts and dress in each other and put 
them on altogether instead of separately. 

Sleep. — A new-born baby should sleep eight-tenths 
of the time the first six months, two-thirds of the 
time up to the fourth year, and take an afternoon nap 
up to the sixth year. The baby should not sleep 

183 



with the mother or nurse, but in a bed by itself. 

A Bed for an Infant — A bed for an infant : The mat- 
tress should be firm but soft, the pillow, if any., thin 
and the covers light but warm. Baby should be laid 
on its right side for the first eight or ten days after 
birth. This is to aid the foramen ovale in closing. 
After this period it should not be allowed to lie too 
long in one position, but turned from side to side. 
This rests the little one and makes it comfortable. 
Often when a baby cries at night simply turning it on 
the other side is so soothing the child will go to sleep. 
A healthy baby should sleep from ten p. m. to five 
a. m. 

How to Put the Baby to Sleep. — The mother and 

nurse should remember it is a matter of habit and 
they can train the baby to go to sleep by itself as 
well as rocking, walking, trotting and singing. The 
baby should have a warm sponge bath and made com- 
fortable. The bath is given more for its soothing ef- 
fect than for its cleansing purposes. The process 
is simple. Just a basin of warm water, soft sponge and 
a soft old towel. Remove all the clothes except the 
band and napkin. Then with the soft sponge, used 
for the face, wrung out of warm water, bathe face, 
head, neck, chest, and back, drying each part as 
sponged. Then a fresh little shirt is put on. The 
little legs and buttocks are then washed and a fresh 
napkin is put on and last the little gown. Baby 
should now be fed and laid in its little cradle while 
awake. If a bottle-fed baby, first put him to bed, then 
efive him the bottle and remain near the bed and see 
that he does not fall asleep until all the food is taken. 
The room should then be darkened and baby taught 
to go to sleep of its own accord. Don't teach a baby 

184 



to sleep with a light, it is injurious to the baby's 
eyes and a bad habit. If baby cries and you are 
certain there are no pins sticking him, no wrinkles 
pressing in the tender skin, the feet are warm, baby 
is clean and dry, then let him have the comforts of 
a good cry, it will not hurt him, but assist in the 
healthy development of the lungs. Disturbed sleep 
is caused first by indigestion, from over feeding or 
feeding too often, secondly, excitement, caused by 
being played with too much before bed time. Hunger 
is also a cause of disturbed sleep. It is, also an 
early sign of illness. Too much sleep is rare. Never 
give anything to induce sleep. 

Exercise. — All animals require a certain amount of 
exercise. Babies as well as older children. Baby 
takes its exercise by screaming, crying and kicking. 
The clothing should be loose so as not to interfere 
with its movements. It is best to provide a certain 
time each day. The room should be warm, all cloth- 
ing except the shirt, band, napkin and socks should be 
removed. Place a mattress or comforter on the floor 
and allow baby fifteen minutes to exercise in. This 
helps much to develop its muscles. If the clothing is 
short, baby can take its exercise without removing 
it, and when quite young on the bed. But the floor 
is best after baby is able to creep. 

The Language of the Baby. — Study the infant's 
language, its crying, and we can tell a good deal 
from the cry of an infant. All babies cry, and from 
fifteen to twenty minutes a day is healthy. It is neces- 
sary to keep the lungs expanded. There are six dif- 
ferent cries of baby we must become familiar with. 
They are the cry of pain, hunger, illness, temper, 
habit and the normal cry. 

185 



The Cry of Pain. — The cry of pain is described as 
strong and sharp, with usually, contraction of the 
features. 

The Cry of Hunger. — The cry of hunger is con- 
tinuous, fretful, rarely strong. It is not a difficult 
matter to determine baby is hungry. Baby searches 
for its food. 

Cry of Illness. — The cry of illness is more often 
characterized by fretfulness and worrying than real 
crying, although easily provoked into real erring. 

The Cry of Temper. — The cry of temper is loud 
and strong. Characterized by kicking and stiffening 
of the body and sometimes becomes violent. Rarely 
baby exhibits the cry of temper before he is six months 
old.' 

The Cry of Habit. — The cry of habit or indulgence, 
the child ceases crying when it gets what it is crying 
for. as to be taken up. rocked, trotted, etc. 

The Normal Cry. — The normal cry is loud and 

strong, the child gets red in the face, in fact screams. 

Too long or frequent crying is abnormal ; it is rarely 
strong, more of a moaning murmur, and at times 
faint. When baby cries at night see that it is com- 
fortable, that the clothes are loose and feet warm 
and that the napkin is clean and dry. If it is alright 
don't take it up. but let it have its cry out. Some 
mothers will object to this, but unless she is a nervous 
woman and it excites her, be firm and she will thank 
you many times for your training. If it has colic, you 
will notice a drawing up of the limbs, and the feet are 
usually cold. 

186 




How to Lift and Carry the Baby. — -Don't grasp 
the baby under the arms. Catch the baby's clothes 
below the feet and slip the left hand 
under the shoulders. This disturbs 
the baby much less ; the entire 
spine is supported and there is ?5F t * t . \ 

no pressure ; the hand is used n 
simply for surpport. Never hold the >^ ' r ~ 

baby in a sitting position on the ,f|f < 
arm. This is injurous to the spine; v^£~..'I^' 
may cause curvature of the spine. /^ \ ' \ 

Baby should be held either lying on ! 
the arm or in the upright position 
held against the chest, and the arm Fig 50 _ T he proper 
supporting baby's back. Sfby er ° f carryins a 

Temperature of Baby. — The normal temperature 
varies. Usually ninety-eight to ninety-nine degrees 
Fahrenheit. Generally ninety-nine degrees. The tem- 
perature is taken in the groin and rectum. If taken in 
the groin the thermometer should be left in five min- 
utes, and one minute if taken in the rectum. The 
rectum is the most satisfactory place to take it. The 
temperature is a very good guide as to the severity of 
the illness in babies and children. But more depends 
on the continuation of the temperature than its height. 
A hundred and two degrees is mild, a hundred and four 
degrees is severe. A hundred and two degrees of tem- 
perature may be found for trivial reasons. In an infant 
for example, lack of water, especially if the weather 
is warm. Constipation will also give the baby a 
temperature. Baby's temperature should be taken 
every day for the first ten days after birth, and 
whenever the baby is fretful and cross. 

187 



Pulse and Respiration. — The pulse varies from one 
hundred and fifteen to one hundred and thirty beats in 
infants, and the respiration normally ranges from 
thirty to thirty-six per minute. Baby's pulse is best 
taken in the temple. 

Nervous Babies. — Why are infants sometimes nerv- 
ous? Because of the delicate structure of the brain. 
It develops as much the first year of life as all the 
years of after life, and for these reasons the baby 
should be kept quiet, have quiet surroundings, should 
receive few visitors, and should not be played with 
until after the third month, and it is better to wait 
until the infant is six months old, and then only in the 
morning, never at bedtime or after feeding. 

Kissing the Baby. — The baby should not be kissed. 
There are many valuable reasons for this. The prin- 
cipal reason is the contraction of contagious diseases. 
It is, also, annoying to the child. If you must kiss 
the baby, let it be upon the head, never upon the hands 
or lips. The hands find their way to the mouth so 
frequently that it is safest to kiss it only on its little 
head. 

The Bowels of the Baby. — The infant's bowels 
should move shortly after birth, twenty-four to forty- 
eight hours. If they do not move examine the anus 
and see if it is open. If not, the condition is serious, 
and the nurse should report the condition to the phy- 
sician at once. Often it is necessary to perform an 
operation. In these cases, like obstruction of the 
bowels in older patients, the infant vomits its food, 
the bowels, of course, do not move, and if this condi- 
tion is neglected its bowels may be emptied in like 
manner. But usually if this condition exists it is 

188 



discovered in a few hours, as the nurse should care- 
fully overlook even- child before washing it immedi- 
ately after birth, and if there is anything abnormal tell 
the physician immediately. The meconium should be 
thoroughly evacuated ; if not give the baby a tea- 
spoonful of pure olive oil. This acts on the baby's 
bowels and does not gripe them. Note the number 
and character of the stools. It aids much in regard 
to the condition of the baby's health. 

Character of the Stools the First Few Days. — For 

the first few days baby passes a thick, dark green, tarry 
material, called meconium. When the infant is three 
or four days old the movements are brownish in color ; 
gradually this color disappears and they become yel- 
low in color. 

Breast Fed Children. — -The normal color and 
character of the stools in breast fed children ; they 
are light yellow in color, soft and smooth, containing 
no lumps ; the consistance of paste or very thick cream 
and usually two movements a day. 

Artificially Fed Babies. — When the baby is fed upon 
cow's milk, the stools are brighter in color, cohesive 
in character and often contain lumps and curds. If 
curds appear in the stools, a change should be made in 
the formula. Sometimes by using a larger proportion 
of cream and a smaller proportion of milk will adjust 
this matter. 

Dark Stool. — The stools may become dark, brown 
or black, from bismuth or iron, and again from th<? 
presence of blood, which is a serious symptom. Frothy 
green, undigested stools ; stools containing mucus, 
curds or blood streaked should be reported to the phy- 

18!) 



sician at once, and the food diluted or omitted, and 
albumen or barely water given. 

Regularity of Habit. — It is an easy habit for baby to 
form to evacuate the bowels daily at a certain time. 
With some trouble on the part of the nurse or moth- 
er, this can be accomplished. The principal rule to 
follow is regularity. A certain hour morning and 
evening should be selected, usually after its eight 
o'clock feeding in the morning, and the four o'clock 
feeding in the afternoon. A small vessel the size of 
a quart cup is held between the nurse's knees ; upon 
this the infant is placed, and the child is held firmly 
against the chest of the nurse. At first we may have 
to irritate the bowels by giving a soap suppository, 
which may be made from a piece of soap one inch 
long by trimming it into a tapering extender. But the 
habit is soon formed, and after a few weeks the posi- 
tion is all that is necessary. Evacuation takes place 
as soon as the baby is placed on the vessel. I have 
had babies of nine weeks who had formed the habit 
and become so regular by training they would wait 
until the time and never soiled their napkins. It is 
surprising how soon they learn and how regular they 
become by proper training. If the bowels are stub- 
born, gentle massage of the abdomen will often give 
good results. But do not let the baby go twenty-four 
hours without a bowel movement ; rather give a gluten 
suppository or a warm saline enema. 

The Kidneys of the Baby. — The kidneys are fully 
developed and the baby usually passes urine shortly 
after birth, but if the funnction should be delayed, warm 
fermentation placed over the region of the kidneys 
and bladder may be all the treatment that is neces- 
sary. But this condition must be watched and if this 

190 



treatment should fail the condition should be reported 
to the physician, and the parts inspected for obstruc- 
tion. Xote. also, if there is a reddish deposit of uric 
acid on the napkin and if so, give the baby freely of 
water to drink; this condition shows the urine is too 
concentrated. 

Airing. — The child, if strong and healthy, should be 
taken out for its first airing when two weeks old in 
summer, and one month of age in winter. The child 
should be taken out daily for an airing when the 
weather permits. In winter be careful to see that it 
is warmly clothed, and when it is very cold a warm 
water bag ma}- be placed at its little feet in the car- 
riage to make it comfortable and keep its little feet 
warm ; be careful and not have it too hot, as it would 
burn its tender, delicate skin. It should not be taken 
out in a high wind or when the ground is covered with 
melting snow. But fresh, pure air is as necessary for 
its growth and development as proper food. 



J91 



CHAPTER XIV. 



FOOD. 



A whole book might be written on this subject, but 
I shall endeavor to give only a few of the principal 
points of interest. From birth until six months old, 
the diet consists of milk, either mother's or modified 
cow's milk. The best food for an infant, under nor- 
mal conditions, is mother's milk, which is composed of 
thirteen parts of solids and eighty-seven parts of 
water. By normal conditions, we mean that the moth- 
er is in perfect health. A woman suffering from an 
infectious disease, such as tuberculosis, syphilis or 
puerperal sepis, should never nurse her child because 
of the danger of infection for the child, and it is too 
great a drain on the mother's strength and vitality. 
That the milk is perfect in quality, and sufficient in 
quantity. Should a mother be unable to nurse her 
child, a wet nurse should be recommended. Mother's 
milk is the food nature has provided for the child, 
and the mother should always nurse her child if pos- 
sible, as man can never exactly reproduce the work of 
nature. If it is impossible for the mother to nurse 
her child or to procure the services of a wet nurse, or 
if the aversion of the patient to wet nurses as a class, 
and this is the rule rather than the exception, cannot 
be over-come, then we must resort to artificial food, 
and this is of the greatest importance. More infants 

192 



die from improper food and the manner in which they 
are fed, then from any other cause. Two-thirds of all 
the children born die before reaching the age of three 
years, and the greater part of sickness and deaths 
among children are due to improper food and the man- 
ner in which they are fed than all causes conbined. 
Think of the little lives that might be saved if parents 
only gave this subject a little more thought and con- 
sideration ! When baby must be fed artificially, cow's 
milk is best. The milk of the ass is more like 
mother's milk than cow's, but it is hard to get. All 
milk contains the same constituents, no matter from 
what animal it is obtained ; the difference lies in the 
proportions of these ingredients. Here is a table giv- 



ing the constitution of each : 







Mother's Milk. 






Fats, 


Sugar, 


Proteids, Salts, 


Water, 


Reaction 


4.0 


7.0 


1.5 2.0 
Cow's Milk. 


87 


Alkaline 


Fats, 


Sugar, 


Proteids, Salts, 


Water, 


Reaction 


3-5 


4-5 


4.0 7.0 


87 


Acid 



By comparison we see that the main difference be- 
tween cows milk and mother's milk is that mother's 
milk contains more sugar and less proteids. So we 
see that cow's millk in its natural state is inadequate 
to replace mother's milk, and is unfit for food for an in- 
fant. We must change the constituents of the cow's 
milk to resemble mother's milk and to make it digesti- 
able for the infant. This process is called "modifying." 
The protieds of cow's milk differ from human milk 
in quantity and quality. This is the element that is 
the tissue builder and strength producer of milk. It 
is more than an infant can digest, and if given in its 

ii3i 193 



natural state will form irritating, hard, tough curds 
in the baby's stomach. We see then that cow's milk 
cannot be fed to an infant without changing or modi- 
fying it. Although it contains the same element as 
mother's milk it is not in the same proportions. But 
it is easy and simple to change or modify it to re- 
semble mother's milk. This is done by adding cream. 
sugar and water. Sometimes whey is used as a dilu- 
tent instead of water, and lime water overcomes the 
acidity of cow's milk, making the reaction alkaline. 
The first step is to obtain the primary formula, the 
ten per cent milk. This is milk containing ten per 
cent fat ; which is obtained by taking equal parts of 
plain milk and ordinary cream, or the upper third of 
a quart bottle of milk after standing at least four 
hours. It is more convenient to use the plain milk 
and ordinarv cream in making: the formulas. 



194 



FORMULA I. 



Third to the fourteenth dav 



Third to the fifth day, 

Number of ounces. 

Ten. 

One ounce at a feeding. 

i / 

1/ 



Milk 
Cream 
Lime water 
Milk sugar 
Boiled water 



Oz. 
Oz. 
Oz. 
Oz. 
Oz. 



sy 2 



Fifth to the seventh day, 
Number of ounces. 
Twenty-one. 
Two ounces at a feeding. 



Milk 
Cream 
Lime water 
Milk sugar 
Boiled water 



Oz. 
Oz. 
Oz. 
Oz. 
Oz. 



i 

i 



Diluted nine times. 



Diluted six time; 



Seventh to the tenth day. 
Number of ounces. 
Twenty. 
Two ounces at a feeding; 



Diluted four times 



Tenth to the fourteenth day. 
Number of ounces. 
Twenty. 
Two ounces at a feeding, 
ilk Oz. 

-earn Oz. 

ime water Oz. 
ilk sugar Oz. 
3iled water Oz. 
Diluted four times. 



Milk 


Oz. 


2 


Milk- 


Oz. 


2 


Cream 


Oz. 


2 


Cream 


Oz. 


2 


Lime water 


Oz. 


I 


Lime water 


Oz. 


1 


Milk sugar 


Oz. 


i/4 


Milk sugar 


Oz. 


i> 


Boiled water 


Oz. 


15 


Boiled water 


Oz. 


15 



The above formulas are to be divided into ten feed- 
ings each, in twenty-four hours. Every two hours by 
day and two feedings at night, if the baby is awake. 
Never wake a child at night for food. If fed at night, 
the hours are usually one and four o'clock. If top 
milk is used, use the ten per cent milk, and take as 
much as milk and cream combined. 



195 



FORMULA II. 

Second to the sixth week. 
Using ten per cent milk as primary formula. 



Third w 


eek 


Fourth week. 


Number of ounces. 


Number of 


ounces. 


Twent 


y. 


Twenty-five. 


Two ounces at 


a feeding. 


Two and a half 


ounces at 






a feed: 


ing. 


Milk 


Oz. 2 


Milk 


Oz. 2y 2 


Cream 


Oz. 2 


Cream 


Oz. zy 2 


Lime water 


Oz. i 


Lime water 


Oz. iy 2 


Milk sugar 


Oz. iy 2 


Milk sugar 


Oz. \y 2 


Boiled water 


Oz. 15 


Boiled water 


Oz. i%y 2 


Diluted four times. 


Diluted four times. 



Fifth week. 
Number of ounces. 
Thirty. 
Three ounces at a feeding- 



Milk 
Cream 
Lime water 
Milk sugar 
Boiled water 



Oz. 
Oz. 
Oz. 
Oz. 
Oz. 



3 
3 

2 

22 T / 



Diluted four times. 



Sixth week. 
Number of ounces. 
Thirty. 
Three ounces at a feeding. 



Milk 
Cream 
Lime water 
Milk sugar 
Boiled water 



Oz. 
Oz. 
Oz. 
Oz. 
Oz. 



3 
3 

2 

22 T / 



Diluted four times. 



The above formulas are for ten feedings each, in 
twenty-four hours. Every two hours by day and four 
hours at night, if baby is awake, usually at one and 
four o'clock. If the ten per cent top milk is used, use 
as much as milk and cream combined. 



196 



FORMULA III. 



Sixth to the twelfth week. 

Using ten per cent milk as primary formula 

Seventh week. Eighth week. 

Xmnber of ounces. 



Twenty-four. 




Twenty-eight. 




Three ounces at a 


feeding. 


Three and a half ounce 
a feeding. 


:s at 


Milk ( )z. 


3 


Milk ()z. 




Cream Oz. 




Cream Oz. 


3^ 


Lime water Oz. 


iy 2 


Lime water Oz. 


t t _; 


Milk sugar Oz. 


154 


Milk sugar Oz. 


i- , 


Boiled water ( )z. 


i6V 2 


Boiled water Oz. 


r r; - i 



Diluted three time: 



Diluted three time: 



Ninth and tenth weekr 
Number of ounces 
Thirty-two. 

Four ounces at a feeding 



Eleventh and Twelfth weeks. 
X umber of ounce-. 
Thirty-six. 
Four and a half ounces at 
a feed in st. 

ii'. 



Milk- 


Oz. 


4 


Milk 


Oz. 


Cream 


Oz. 


4 


Cream 


Oz. 


Lime water 


Oz. 


T T 2 


Lime water 


Oz. 


Milk sugar 


Oz. 


2 


Milk sugar 


Oz. 


Boiled water 


Oz. 


22 T/ 2 


Boiled water 


Oz. 



Diluted three times. 



Diluted three times. 



The above formulas are to be divided into eight feed- 
ings each, in twenty-four hours, every three hours dur- 
ing the day, and one feeding- at night if the baby is 
awake. Usually about two o'clock. 

These formulas may be continued until the baby is 
four months old. It is often better to increase the 



197 



quantity first, and then if baby is not satisfied, the 
quality. But I have found babies thrive much better 
on a weak formula ; the gain is not so rapid, but they 
do not seem to have the stomach complications that 
rich, over-fed babies are victims of. The next series 
of formulae for the middle months, a change is made 
in the milk. At this period the seven per cent milk is 
used as a dilutent instead of the ten per cent milk. The 
seven per cent milk is obtained as top milk, by tak- 
ing the upper half of a quart bottle, after it has stood 
at least four hours, or by using one-fourth ordinary 
cream, containing sixteen per cent fat, and three- 
fourths plain milk. At this age, also, the number of 
feedings are seven in the twenty-four hours, every 
three hours by day and none at night. Usually at the 
age of six months the infant needs a more mixed diet. 
Farnaceous food in some form, usually as strained 
gruel, may be added to its mid-day feeding, and 
strained broths may be given to some children at this 
age. But, as we are dealing only with the new born 
infant of four days to three months (this includes the 
length of time the nurse is with the little stranger)' 
we will not go into details of foods required later. 
A nurse should be very careful, and never prescribe 
any form of food. This is the physician's duty, and he 
should prescribe the food as he does the medicine, giv- 
ing the nurse a written prescription for its prepara- 
tion. The above or foregoing tables are only used in 
an emergency, or in the absence of the physician. The 
same proportions are not suited for every case, and 
must be often modified, by experience, to suit the in- 
dividual child. According to the health of the child, 
these conditions should be changed to meet its de- 
mands. As infants have no stomach at birth, only 

198 



an enlargement of the alimentary canal, which forms 
a kind of a pouch, holding about one ounce, two table- 
spoons, how important, then, that the specified amount 
be given, and at regular intervals. How important for 
the nurse, that she understands this all-important 
duty, and is equal to her responsibilities. That she 
knows what is best for each child in order that it may 
thrive and grow. Cow's milk, modified according to 
the needs of each individual child, is the most perfect 
food for an infant deprived of mother's milk. 

How to Feed the Baby. — Never feed a baby lying in 
bed, except at night. The infant should be taken up 
and held in the same position as a mother holds her 



rfte 





Fig-. 51 — The proper manner of holding- a babv when giving it the 

bottle. 

child when nursing it. The infant should nurse con- 
tinuously. Never allow it to go to sleep and then 
wake up and continue to nurse. Never allow it to 
nurse more than fifteen or twenty minutes. If it seems 
sleepy, try and keep it awake by gently shaking or 
moving it so as to rouse it until it empties its bottle. 
If this does not succeed, try washing its face with cold 

199 



water. Should this fail, take its bottle away and let it 
wait until next feeding. Do not feed it between feed- 
ings. Give it water if fretful. All water given an in- 
fant should be boiled, and given at a temperature of 
one hundred F. Always use a dairy thermometer 
in testing the heat of the milk, and it should be given 
to a child at one hundred degrees F. The bottle 
should have a piece of flannel wrapped around it so 
it will keep warm until baby takes it all. A child that 
is fed from a bottle should be nursed as regularly as an 
infant that is fed from the breast. A young baby 
should be fed every two hours during the day and 
twice during the night, if awake. Or ten feedings 
during the twenty-four hours. A baby should be 
awakened during the day for its food at the 
proper time, and it will soon learn to awake of its 
own accord. Its health depends upon regularity. 
Never wake a baby at night ; it may sleep the whole 
night through, if it will, without feeding. At live 
weeks it is usually fed every two and a half hours dur- 
ing the day and once at night ; if awake, until three 
months old, at which time it is fed every three hours 
during the day and no feeding at night. Bottle-fed 
babies are usually pale, but thrive fairly well. The 
success depends on scrupulous cleanliness in regard to 
the bottles, nipples and the preparation of the food and 
regularity in feeding*. As soon as baby finishes tak- 
ing its bottle, it should be laid gently in its little bed. 

HOW TO PREPARE THE FOOD. 
Material and Appliances Used in its Preparation. 

Material Needed.- — The material needed is milk, 
cream for top milk), lime water, milk sugar and 
boiled water. 

200 



Appliances Needed. — A Nelson's siphon. This may 
be obtained at any surgical supply house, or by tak- 





Fig. 52— Nelsons Siphon. Fig-. 53— Langerfeld's sterilizer. 

ing a long, straight glass tube, heating it and then 
bending it the shape desired. It should be V shape 
with one arm twice as long as the other. This is used 




Fig. 54 — Gran- 
ite pitcher. 



Fig " 
Glass 
funnel. 




Fig. 57 — B rush 

with wire handle 

for cleaning the 

bottles. 



Fig 56 — Graduate measuring glass. 8 oz.. 
used in preparation of baby's food. 



to siphon off the top milk, if top milk is used. Feed- 
ing bottles, sterile cotton to cork them with, rubber 



201 



nipples, a vessel for mixing, usually a large granite 
pitcher, this must be used for nothing else but 
baby's milk, a glass funnel, and an eight ounce 
graduate measuring glass, a stiff bottle brush with 
a wired handle, a granite cup to boil the nip- 
ples in, to be used for this purpose and no other, 
and a deep granite cup for warming the bottles of 




Fig. 58 — Food warmer 



milk. A nice little alcohol warmer can now be had 
at most drug stores costing less than a dollar. These 
articles with a dairy thermometer complete our ap- 
pliances. 

To prepare the bottles. — Prepare the number re- 
quired for the number of feedings in the twenty-four 
hours by boiling twenty minutes in a solution of bi- 
carbonate of soda, then rinse them with plain boiled 
water and alloAv them to remain in same until needed. 

202 



It is best and safest to allow for accidents by prepar- 
ing two extra feedings. After each feeding the bottle 
should be rinsed with cold water and rill with same 
until they are prepared for the reception of the milk. 

The Preparation of the Formula.— The nurse pre- 
pares the formula given her by the attending phy- 
sician. The physician should give a written prescrip- 
tion for the preparation of the infant's food, as he does 
for the prescribing of medicine, and the nurse should 
carefully and conscientiously fill same. Prepare the 
entire twenty-four hours' feeding- at a time. The 
cream, or top milk, is first siphoned off. To accom- 
plish this, the Nelson's siphon is used, or the glass V- 
shape tube. If the tube is used, a piece of rubber tub- 
ing is fastened to the long arm and the tube is then 
filled with water and the rubber tube held compressed 
with the fingers. The short arm is placed in the bot- 
tle and the top milk will flow in the vessel held be- 
neath. With the siphon is full directions for use. The 
sugar is dissolved in the water, the cream, milk, or 
top milk and lime water is added. Use the pitcher 
for mixing- it in and the graduate glass for measuring 
the ingredients. After mixing it well, put it in the 
sterile bottles and set them in a pan of water and 
place the pan on the stove. The water should reach 
two-thirds the height of the bottles. Let it remain 
on the fire until the milk in the bottles reaches 167 de- 
grees F. Always test the heat with the dairy thermom- 
eter. The bottles are then corked with sterile cotton, 
removed from the fire and as soon as cooled place them 
in the refrigerator or ice box, and it should be kept at 
a temperature of forty-two degrees. Open only when 
needed. AYhen a bottle is once opened, if baby does 

203 



not take it. or only a part, it must not be given the 
baby again, but thrown away. 

Pasteurizing Milk. — Pasteurizing milk means heat- 
ing it to one hundred and fifty to one hundred and sev- 
enty degrees F. 

Sterilizing milk. — Sterilizing milk means heating it 
to two hundred and twelve degrees. 

Both these processes are to destroy bacteria. Some 
authorities tell us that, unless there is good reason for 
so doing it. it is best not to either pasteurize or sterilize 
the milk, as heating interferes with the digestibility of 
the milk. Of course, if the nurse has reasons to believe 
the milk is not pure or clean, then pasteurize it. AYe 
seldom sterilize milk, unless we want to preserve it. as 
for example, an ocean voyage, so as to keep it sweet. 
Pasteurizing milk renders it harder for an infant to 
digest. 

To Heat the Milk. — Place the bottle in cold water. 
Do not put it directly in hot water, but in cold water. 
If put directly in hot water, when taking it from the 
ice box. it is apt to crack the bottle. After the chill is 
oil. the bottle is then placed in warm water. When 
the water is cool refill with warmer water, then hot 
water. The water should reach the neck of the bottle. 
Allow it to remain in hot water until the milk in the 
bottle reaches a temperature of ico degrees F. Shake 
it several times so that the heat will be uniform. Thus 
the milk is heated gradually and a bottle is seldom 
cracked or lost. Always prepare two extra feedings 
in event of a bottle ma}" be spilt or broken. 

To Tell Good Milk. — Milk chosen for an infant's 
food is usually selected from a mixed herd of several 
healthy cows, fed on a clean pasture. A mixed herd is 

204: 



preferred, when possible, to a single cow. because the 
milk is more uniform in quality and not so apt to 
spread diseases as would be the case in a single cow. 
If the milk is good, it should be acid in reaction ; have a 
dense white color and if tipped to the side of a glass, 
you will see a distinct film, and when placed on the 
ice cream rises to the surface. 



The Bottles. — The bottles should be the rounded 
graduate ones. Rather wide necks are to be pre- 
ferred, as they can be more easily and thoroughly 
cleaned. After each feeding rinse well 
with cold water so the little milk that 
adheres to the side will not sour and 
remain adherent. Fill them with clear 
water, in which a little bicarbonate of 
soda is added ; allow them to remain so. 
Before using wash them well with a 
long handle stirt brush that is made for 
this purpose, and boil twenty minutes 
in a bicarbonate of soda solution. A 
teaspoonful to a pint of water. The 
"Hygeine" nursing bottle is best, as 
we are sure of being able to clean this 
perfectly. 

The Nipples. — The nipples should be 
the best black rubber nipples that lit fi?. 59. 

over the bottles. Xever use a nipple A ^ aduate nurs " 

r L ing bottle. 

with a tube attached to it. It is impos- 
sible to clean these as they should be. and thev are 
dangerous. Neither use one that has a large hole in 




205 




it. The hole should be of such a size that when the 
bottle is inverted the milk drops easily, 
but does not run in a stream, as baby 
would take its food too rapidly, which 
would cause stomach disturbance. Im- 
mediately after nursing, the nipple 
should be removed from the bottle and 
thoroughly washed, at first outside, then 
inverted and the inside washed well 
also. The nipples should then be placed 
in a cup or small vessel, containing a 
saline solution ; this prevents them be- 

Fig\ 60— Rubber . 4m 

mppie. coming soft. They are kept here until 

boiled. A nipple must never be used a second time 
without boiling. After boiling the nipples should be 
kept in a three per cent boric acid solution until used. 

Other Foods. — There are numerous baby foods on 
the market. Some babies seem to thrive on them and 
do fairly well. In some instances they are added to the 
milk formula. Condensed milk agrees with most 
young babies, but is apt to be constipating. If such 
is the case, a little olive oil, given the baby or a little 
cream added to one or two of its feedings, will usually 
adjust this condition. Horlick's malted milk is an ex- 
cellent food for the baby. 

The Wet Nurse. — If possible, when the mother can 
not nurse her child, a wet nurse should be procured. 
The nurse should be between twenty and thirty-five 
vears of age, and a thorough medical examination as to 
her health and constitution should be made by the phy- 
sician in charge of the case before accepting such a 
person to nurse the child, and her own child should 
be as near the age of her adopted charge as possible. 

206 



Weaning the Baby. — This is hardly necessary to 
mention here, as I have intended this book simply as a 
guide or assistant to the young and inexperienced 
nurse, and to include only from the period of concep- 
tion to the infant of three months. It is inserted here 
for the sake of completion. The weaning of the baby 
is sometimes a difficult task. The infant will often re- 
fuse its food until nursed. Under usual normal con- 
ditions, weaning should begin at nine months and be 
completed at one year. In summer it may, sometimes, 
be advisable to nurse the child a little longer, rather 
than wean it if the weather is very warm, especially if 
teething. To overcome the difficulty it should be done 
gradually ; begin by substituting one feeding a day 
for one nursing. Then two feedings a day for two 
nursings. It is better to accustom the infant to other 
foods by the means of mixed feedings, then to take 
the mother's milk away suddenly. Thus the child is 
taken from the breast gradually and the dangers of 
digestive disturbance is lessened. 

Water for the Baby. — Too much can not be said 
in regard to this subject, as this is one necessity that 
is often neglected and the baby suffers for want of "it. 
The child becomes restless and will not sleep, is very 
cross and fretful. Babies often have fever and are cross 
and fretful for lack of water. A new-born baby should 
have one ounce of water each day. The water should 
always be boiled and given warm. As baby grows 
older, the quantity should be increased. It should be 
given a teaspoonful at different intervals during the 
day until the allowed amount is taken. Best given 
between feedings. 

Weight of Baby. — The average weight at birth is 
seven and a half pounds. Boys usually weigh a half 

207 



a pound more than girls. The infant loses the first 
three days after birth, but after the milk appears on 
the third day, the baby begins to grow and gain, so at 
the end of a week it should weigh what it did at birth. 
It should gain from one-half to one ounce daily for the 
first three months; after that the gain is not so great, 
but it should average from four to six ounces a week 
the first six months, and from one to three ounces a 
week from six to twelve months. A child should be 
weighed once a week for the first six months, and 
always on the same day of the week, and once a 
month on the same date of the month from six 
months to one year old. The weight of the child is 
very important. It is an accurate guide as to the 
health of the child. It is well to remember that seem- 
ingly simple things will cause the weight to vary, such 
as wei°;hinq- the babv immediatelv after feeding ; the 
food it has consumed would increase its weight sev- 
eral ounces. In weighing the baby with the clothes 
on, the varying weight of these at different times 
will cause discrepancies, then again the movement of 
the bowels just before weighing will cause an ap- 
parent loss. So that a mother or nurse must consider 
these things before considering there is an actual 
loss in weight. 

Keep the Baby Clean. — The infant should be kept 
spotlessly clean. Soiled and wet napkins should be 
removed immediately. The buttocks should always 
be washed and carefully dryed after each movement. 
Great care should be exercised in keeping the bib and 
dress, clean. Remove same immediately should the 
infant regurgitate its food. Nothing is more disgust- 
ing than a sour-smelling baby. 



208 



CHAPTER XV. 

ILLS OF BABY. 

Ailments that Often Affect Baby During the First 
Three Months of Life. 

In this chapter on the "Ills of Baby.'' I shall en- 
deavor to narrate, in order, the dangers and ailments 
that baby is apt to encounter during its hrst three 
months of life. I do not mean to describe all the 
dangers that may befall baby, but the ones of ordi- 
nary occurrence. The first one on the list is one that 
may occur even before the birth oi the child, and is : 

Asphyxia Neonatorum. — This condition ma}' occur 
either before or immediately after delivery. It is 
caused by the too early separation of the placenta 
and by pressure on the umbilicus cord during de- 
livery. The child when born is either blue and stiff. 
or very pale and limp. The heart beats, if heard at 
all. are very faint. Unless respiration can be induced 
the child will die. 

Treatment. — The treatment consists in using all the 
means we have to encourage and stimulate the respir- 
atory organs, and the using of several methods to 
produce artificial respiration. The treatment should 
be persevering but gentle. The author knows of one 
case where the physician worked with a baby one 

14 209 



hour before it responded to treatment. It lived and 
is a fine child. So we should continue gentle treat- 
ment, even if it seems useless and the child dead. 

Simple Treatment. — Perhaps the simplest treatment 
and one that is very effectual is to before cutting 
the umbilicus cord, hold the infant up by the feet, 
head downward, and spank it. This often is all that 
is necessary. 




Fig. 61 — Resuscitation of an asphyxiated baby. 

Shock. — In mild cases of asphyxia, where the 
simple treatment does not have the desired results, 
the most common method used is that which will 
produce a shock. Sometimes the simple sprinkling 
of cold water on the chest or back is sufficient to cause 

210 



the infant to catch its breath and cry. Some phy- 
sicians place the baby in a hot bath, 106 degrees F., 




Fig-. 62 — Bird's method of resuscitating- of asphyxiated infant. 
First motion. Expiration. 

while others use hot and cold water alternately. 
Shock, in mild cases of asphyxia, will be sufficient to 




Fig. 63 — Bird's method of resuscitating of asphyxiated infant. 
Second motion. Inspiration. 

bring about normal breathing. The little one must 
then be wrapped up warm; a hot water bottle placed 

211 



in its little bed to preserve the heat of the body, and 
the child watched carefully for several hours. 




Fig-. 64 — Sylvester's method of performing artificial respiration. 
First motion. Expiration. 

Artificial Respiration. — Of this treatment there are 
two methods. One known as, "Byrd's," which con- 
sists of alternately folding and infolding- the child up- 
on itself like a book, and the "Sylvester's" method as 
used in resuscitating a drowned person, which is pro- 
duced by alternately raising the arms high above the 




Fig. 65 — Sylvester's method of performing artificial respiration. 
Second motion. Inspiration. 

head and pressing them down again close to the sides. 
To be repeated twenty times a minute. 

Another Method. — Another method, which is often 
effectual, is to place one hand firmly on the child's 
stomach, and hold the nostrils with the other. A 
piece of gauze or very thin cloth is placed over the 

212 



child's mouth, and air is forced into the child's lungs 
by blowing gently through the cloth. Repeat about 
twenty times a minute. And in trying to inflate the 
lungs, blow very softly and slowly. 

Blue Babies. — Of these there are two classes; the 
first one is caused by failure of the wall between the 
two sides of the heart not closing properly. The 
blood is not properly oxygenated in the lungs; the 
arterial and venous blood mixes, the skin of the baby 
is blue, and we have that condition known as ''a blue 
baby." The baby may live, but usually the child is 
not strong and dies young. 

The second condition in new-born babies which 
produces like effect is known as atelectasis. The lungs 
do not unfold and expand as they should. The chil- 
dren are blue and cold. It is usually fatal in the 
course of a day or two. It is more common in pre- 
mature babies and offsprings of delicate parentage. 
The babies often thrive better if kept in an incubator. 

An Improvised Incubator. — When it is necessary 
that baby should be placed in an incubator for a short 
time, if it is impossible to obtain one, a clothes 
basket may be used for this purpose ; a soft pillow is 
placed in the basket for baby's bed, and the infant is 
kept warn by hot water bottles. The following incu- 
bator I improvised in an emergency and found it very 
satisfactory. 

My Incubator. — Take a large cracker box, or any 
clean box the right size will do. The box should be 
large and deep enough, according to baby's size and 
length, and size also to allow room enough for its little 
bed, and the hot water bottles that are to heat the 
incubator to the proper temperature. The box should 
have holes bored in it with a large gimlet, or cut 

213 



small holes with a pen knife all around the sides so 
there will be proper ventilation for baby. The incu- 
bator should be heated with hot water bottles, or 
what is better still, Japanese stoves. The stoves, if 
you can get them and enough of them, keep a more 
even temperature, do not cool off like the hot water 
bottles. A nail is driven in one end of the box and on 
it is hung a weather thermometer. The temperature 
should be between 92 to 94 degrees F. The tempera- 
ture should not be allowed to go below 92 degrees F. 
or above 94 degrees F. Then baby's bed. This should 
be raised about six or seven inches from the floor 
of the box ; it should be made of laths or very thin 
plank with spaces between them. This is to allow free 
passage of heat. On the little bed frame is placed a 
soft, thin pillow, or several layers of cotton ; over this 
a clean soft cloth, and baby's bed is complete. Baby 
should have on a little shirt and napkin, and only 
very light covers ; a very thin blanket. If baby is kept 
too warm it will have a rash. The top of the incu- 
bator box is closed by a large pane of common window 
glass. The glass answers a two-fold purpose, keep- 
ing the heat in, and the nurse can see the baby and 
thermometer without removing same. My incubator 
is now complete. Be sure baby has plenty of venti- 
lation ; that the holes in the side of the box are large 
enough and sufficient in number. 

Hemorrhages. — Many children are rendered quite 
weak and not a few die of hemorrhage. In the new- 
born infant it is more often hemorrhage of the um- 
bilicus that is of special interest to the nurse. She 
should watch the child for an hour of two after birth 
to be sure that no hemorrhage occurs. If so it should 
be treated as has already been described. 

214 



Delayed Urination. — The baby's kidneys should act 
shortly after birth. If they do not. inspect the parts 
to be sure they are normal. If so, do not be alarmed 
if urination be delayed. Give the baby all the warm 
water it will take, or two drops of sweet spirits of 
nitre every hour until the kidneys act freely. In lit- 
tle boy babies the orifice of the prepuce is sometimes 
so small or the foreskin is so tight that it forms a 
stricture or compress so that the passing of urine is 
accomplished with pain and difficulty. This is a 
serious condition. The foreskin being so tight causes 
stricture of the uretha, retention of urine, fretfulness 
and nervousness and is responsible for many of the 
nervous conditions in later years. When this condi- 
tion is present the operation known as circumcision is 
usually performed. 

Circumcision. — This is the oldest surgical opera- 
tion known. It has been performed for centuries. It 




Fig-. 66 — Infant prepared for circumcision. 

215 



was formerly an exclusively a religious rite of the 
Jewish faith, performed on all male Hebrews eight 
days after birth ; the ceremony being performed by 
the Jewish rabbi. While still a religious ceremony of 
the Jewish church, it is not exclusively a religious rite 
now, but is performed by physicians on all male chil- 
dren whenever physical conditions make it necessary. 
The only instruments necessary are a pair of artery 
forceps, a pair of scissors, suture, needle-holder, a 
little sterile cotton and gauze, a bichloride solution. 
and a narrow crinoline bandage. Boric acid powder 
or aristol. The little patient is placed on the table, 
the clothes are thrown back and a towel folded back 
over them, the napkin is removed and the field of op- 
eration is washed off with a bichloride solution in the 
strength of one to rive thousandth. A sterile cloth 
with a hole cut in it large enough to allow the penis 
to pass through, and also large enough to hang down 
and cover the buttocks, so in case the baby's bowels 
move there is no danger of the operator soiling his 
hands, and a folded napkin is placed immediately under 
the buttocks as a protection. The foreskin is pushed 
forward and held with the artery forceps and the sur- 
geon clips it off with the scissors. Often there is 
some hemorrhage. Regarding after-care the nurse 
must observe surgical cleanliness in regard to the after- 
care of the wound. It must be washed off after each 
urination by allowing some warm boric acid solution 
to flow over the penis. Dry the part with sterile cot- 
ton, powder it with boric acid powder or aristol. A 
large pad of dry sterilized cotton is placed over the 
parts to protect them and prevent the napkin rubbing 
and irritating them. It usually heals in three or four 
days. Some surgeons use suture, others prefer the 
narrow crinoline bandage. 

216 



The Bowels. — The bowels should move in twenty- 
four hours after birth. It is well on the morning of the 
second day to give the baby a teaspoonful of olive 
oil. Olive oil is preferable to castor oil, because it 
does not gripe the baby, and clears the intestinal tract 
of the meconium. The meconium should come away 
early ; the mother's milk is often sufficient for this 
purpose, but if the collostrum is scant, the olive oil 
will be very effectual in ridding the infant's intestinal 
tract of this substance. Of course the nurse will 
discover when she takes the infant's temperature if 
there is an occlusion of the anus, and if so notify the 
physician immediately, as an operation must be per- 
formed. New-born infants seldom suffer from con- 
stipation, although when a few months old, bottle 
babies especially suffer sometimes from this com- 
plaint. Diarrhea is more frequent/ in a new-born 
baby, until after the milk has become regular and the 
collostrum is absent. Bottle babies suffer more from 
bowel and stomach complications than breast-fed 
children. The treatment is the physician's duty, to 
regulate the milk. In bottle-fed babies the milk should 
be diluted, and we can dilute the milk of breast-fed 
children by giving them a certain amount of water to 
drink before nursing- and not allowing them to nurse 
full time. 

Jaundice. — This is a yellowish discloration of the 
skin in new-born infants. It usually makes its ap- 
pearance from the third to the ninth dav. It is sup- 
posed to be due to inefficiency in the action of the 
liver, causing an accumulation of bile in the blood, or 
a congested liver. The bowels are usually affected. 
The bowels should be hushed daily with a saline 
enema, and the writer has found a one-twentieth of a 

•2i; 



grain of calomel triturate dissolved in a teaspoonful 
of water and given to the infant (be sure the baby gets 
the medicine, as it is very heavy and settles on the 
bowl of the spoon), followed in an hour by a teaspoon- 
ful of olive oil is very effectual. Have never been 
disappointed in the results. 

Infection of the eyes. — Ophthalmia neonatorum or 
infection of the eyes is an acute purulent infection 
of the mucus membrane of the eyes of the new-born 
infant. It is usually caused by the gonorrhea germ. 
While there are a few other germs that may cause 
this condition, this is the most common and frequent, 
cause. The germ gains access to the eyes from the 
vagina while the infant is passing through, or is wiped 
into the eyes at the first attention given them 
after birth, or the infant may get its little hands up to 
its face and eyes while the nurse is giving her at- 
tention to the mother immediately after birth, if the 
nurse is not careful to see that its little hands are held 
down by wrapping the blanket around them and its 
little face expossed, and thus it infects itself. But in 
what ever way the germ gains entrance, it quickly 
sets up a violent inflammation of the conjunctiva. 

Prevention. — The prevention of this terrible affec- 
tion, which is the cause of one-third of all the blind- 
ness in the world, is the precaution we use at birth. 
The infant's eyes should be carefully washed, as has 
already been described, and the Crede's method in- 
sures additional safety where conditions are doubtful. 

Symptoms. — This condition usually makes its ap- 
perance on the third day. The first symptom is the 
margin of the lids grow red ; this is followed by a thin, 
watery fluid which is very irritating. After a few 

218 



hours the fluid becomes purulent and the lids become 
so swollen that the eyes are closed. 

Treatment. — If only one eye is affected the other 
eye should be protected by placing a pad of cotton 
over the sound eye and over this a shield, and the 
baby should lie on the side of the affected eye. This 
prevents the possibility of the discharge running 
over the bridge of the nose, being absorbed by the 
cotton,, and infecting the sound eye. Usually the 
first few hours ice compresses are kept constantly on 
the eves. To accomplish this a piece of ice is placed 
in a basin, over this is poured a saturated solution 
of boric acid, and it is well to place a tablespoonful 
of boric acid crystals in the basin, so as the ice 
melts the solution will not became too much diluted. 
Pieces of absorbent cotton large enough to cover 




Fig-. G7 — Arrangement for the application of ice compresses to the 

eyes. 

219 



the eye is cut and placed in the ice cold solution. The 
baby is then placed on a pillow, a hot water bag is 
placed at its little feet and the nurse sits in a com- 
fortable place at the child's head and applies the 
compresses continuously. Do not allow them to 
remain on until they become warm. Often it is neces- 
sary to change them every thirty seconds. The cold 
application is to reduce the inflammation. Paper 
bags should be provided and into them should be 
deposited the compresses as used and all other waste 
dressings that come in contact with the baby's eyes. 
These must be burned. The lids must be kept free 
from all secretions. The discharge is very irritating*, 
and there is great danger of the ulceration of the 




Fig. 68 — Arrangement for the irrigation of the eyes. 

220 



cornea and the loss of the eve. The best method for 
removing the pus from the eye is a gentle stream 
of boric acid solution. The nurse places the child on 
her lap, on a piece of rubber sheet or oil • cloth. 
There should be a large piece of absorbent cotton 
placed immediately under the sides of the face of 
the baby. If only one eye is affected, the infant is 
placed on the affected side ; its little arms must be 
bound down to its sides, so that infection may not 
be carried by the little hands, and it is much easier 
to treat them if baby is unable to use its hands. The 
writer has found a soft rubber ear syringe the best 
irrigator ; it is safer, as children are prone to struggle 
and there is no danger as may be met with in using 
a hard-pointed irrigator. The solution is poured in 
a clean cup and the irrigator, holding about four 
ounces, can be rilled in a few seconds. The child is 
held in a comfortable position on the nurse's lap. 
a piece of rubber sheeting or oil cloth is placed im- 
mediately under its head. A large 
pad of absorbent cotton is placed 
under the side to catch the water and 
discharge, the left hand steadies the 
child's head and with the left thumb 
and index finger the lids are sepa- 
rated. The irrigator is held in the 
right hand, which rests on the in- 
fant's head and steadies and holds it 
gently against the knee, while the 
nurse directs the gentle stream of the 
irrigator at the inner canthus of the 
eye and washes everything outward. 
By gentle pressure just above and be- 
low the margin of the lids, will cause 




Fig-. 69— Soft rub- 
ber ear syringe, ex- 
cellent as syringe 
for the eyes if ef- 
fected. 



221 



them to turn slightly outward, and the inner surface 
of the eye can be perfectly irrigated. It should be 
wiped dry with the little cotton balls that have already 
been discribed. If both eyes are infected, it is more 
convenient to place the baby on a table, treat one side, 
and then turn the baby on the other side and give it 
the same treatment. The eyes should be irrigated 
every two hours while there is any discharge ; little 
cotton balls should always be made and ready for use, 
to wipe off all discharge between irrigations. Pro- 
torgal, one drop in each eye, if both eyes are affected, 
every four hours, is prescribed by most physicians in 
addition to the irrigation. If only one eye is affected 
the other must be inspected from time to time for evi- 
dence of infection. 

Precaution to Prevent Infection.- — During the treat- 
ment and care of such a case the nurse must use the 
greatest care to prevent others becoming infected 
as well as herself. All dressings and the cotton used 
on the infant's eyes must be deposited in paper bags, 
and burned. This the nurse must attend to herself. 
The pillow slips and little dress or gown and all that 
comes in immediate contact with the discharge from 
baby's eyes, should be placed, as soon as removed or 
soiled, in a one to one-thousandth bichloride solution or 
a one to twenty carbolic acid solution, and should re- 
main in it at least twelve hours. If there are other 
children in the house they must not be allowed to go 
in the nursery. All articles used on and about the 
baby must be kept in the nursery and the nurse must 
take care of them herself. And the nurse must not 
neglect herself. Be careful that the discharge does 
not soil her dress. She should wear a large obstetrical 
gown when irrigating and treating the eyes, this to be 

222 



worn only during the treatment. Then she must be 
very careful of her hands. Wash them well, disinfect 
them thoroughly after each treatment and whenever 
they are soiled by the discharge. The best disinfect- 
ant is a one to five-thousandth bichloride solution, the 
hand to remain in it several minutes. Bichloride 
solution is hard on the hand and carbolic acid is pref- 
erable when the treatment must be kept up for some 
time. Sterilized rubber gloves are excellent, but are 
a little awkward. The nurse should avoid her own eyes 
and face as much as. possible ; there is always a pos- 
sibility of contamination. 

Difficulty in Nursing. — The causes of difficulty in 
nursing are several, but the two most common are 
first, ignorance on the part of the baby ; it does not 
know how to take hold and suck, and secondly, 
neglecting to teach it how during the first two or 
three days of life and allowing the breast to become 
so ingorged that the infant can not take hold, and 
thirdly, trying to force a crying baby to take the nip- 
ple the first time. The nipple should be pulled out 
and the child taught to suck before the milk appears. 
Take the baby when partly awake, lay it in a comfort- 
able position near the mother, flat on the bed on the. 
same angle as the nipple, rub its little head so as to 
rouse it and in a short time baby will usually take 
hold. Sometimes it is necessary to put a little sweet- 
ened water on the nipple, or a little milk squeezed 
out of the breast in a spoon, and while baby is trying 
to nurse allow it to run on the nipple and into baby's 
mouth as it is nursing. This will encourage it to try. 
If difficulty is experienced and the breast or nipple are 
not at fault, examine the child's mouth and see if the 
conditions are normal. See if the tongue is tied or 

223 



the mouth sore, and if conditions are abnormal report 
same to the physician immediately. If conditions are 
normal a little perseverance is all that is necessary to 
overcome the difficulty. 

Vomiting. — "When vomiting occurs a few minutes 
after baby takes its food, bottle or nursing, it is 
either because it has taken more than the specified 
amount, the quantity is too large, or the food has been 
taken too rapidly. This is especially true in bottle- 
fed babies where the hole in the nipple is large. It 
is sometimes due to the binder being on too tight and 
presses on its stomach, and sometimes because there 
is too much fat, the milk is too rich. At the time of 
birth the stomach of a baby is simply the dilation 
of the gullet running from the throat to the stomach, 
and holds about one ounce. At the end of four weeks 
it has attained the capacity of two ounces and con- 
tinues to grow and develop slowly and at twenty 
weeks or rive months reaches the capacity of little 
over five ounces. To this condition is due the fact 
that babies can eject the contents of their stomachs 
very easily. A slight movement or pressure is all 
that is necessary to cause baby to throw off a surplus 
of milk. A baby vomits without effort and with 
comfort. This is a wise provision of nature to pro- 
tect the child. For these reasons a baby should never 
be played with or moved about immediately after 
nursing. If vomiting takes place an hour after feed- 
ing it is a symptom of indigestion. In bottle-fed 
children the formula should be made weaker and in 
breast-fed babies the mother's diet should exclude all 
fats and she should eat principally cereals and starches. 
Should baby vomit anything but milk the physician 
should be notified. 

224 



Indigestion. — This is most common of all ills baby 
is heir to. More frequently found in artificially-fed 
babies than breast-fed children, yet both may suffer 
with this complaint unless there is regularity in feed- 
ing the child. 

Symptoms. — The symptoms are vomiting, colic, 
restlessness. The stools are green, containing much 
mucus and large particles of undigested milk curds. 

Treatment. — The treatment consists in the remov- 
ing of the cause. The child's food should be diluted 
or if the case is severe, it is best to take the food 
away for a day or two and the infant fed on barley 
water or albumen water until the stomach has rested 
and vomiting- ceased. With regularity in regard to 
amount and interval of time between the feedings 
this difficulty may be avoided. 

Colic. — This is one of the symptoms of indigestion, 



'/:>,,; 



" l,kJ -- t fc '', mm 



m 



Fig-. 70 — Infant's syringe for rectal injection. 

although it may rarely occur when the stomach and 
bowels seem to be in perfect condition. 

Symptoms. — The symptoms of colic are a sharp cry 
with a drawing up of the feet. The little one will often 
awaken from sleep, utter a sharp cry, there is a rumb- 
ling of the bowels and gas is passed by rectum. 

Treatment. — For colic the best thing I have ever 
used, one that seldom fails, and also one that is harm- 

[15] 225 



less, is a high saline enema, using for this purpose a 
soft velvet eye catheter. Place a piece of rubber sheet- 
ing or oil cloth on the bed or several layers of newspa- 
pers will do, over this one of the baby's little pads or 
napkins. The baby's napkin is then removed and it 
is laid on its side,, its little clothes folded back well 
out of the way. Immediately under the buttocks a 
large pad of absorbent cotton is placed to catch the 
water and feces that will be expelled. The catheter 
is oiled and inserted as high as possible and the enema 
given slowly. From two to four ounces is given at 
a time, repeated several times until the bowels are 
emptied. In expelling the enema the gas is also ex- 
pelled and the baby usually goes quietly to sleep. The 
room should be well heated and the infant not exposed 
to draughts. Do not give peppermint or brandy water. 
These upset the stomach and cause indigestion and do 
more harm than good. See that the infant's feet are 
warm; if not apply a warm water bag to them. Be 
sure the water in the bag is not too hot. Baby's skin 
is very sensitive. 

Infection of the Umbilicus. — It must be remembered 
that the umbilicus is a surgical wound and subject 
like any other wound to infection. The same care that 
is exercised regarding the hands of the nurse and 
dressing of surgical wounds must be observed in 
dressing and handling the stump of the umbilicus 
cord. Direction for the treatment and dressing of 
same has already been given. 

Tetanus. — Tetanus is caused by infection, usually 
of the umbilicus cord. A lack of asepsis in tying, cut- 
ting or the after-care of the umbilicus cord. It is 
always fatal. 

226 



Hernia. — Umbilicus hernia is not uncommon and is 

due to imperfection of the Avails of the abdomen in 
early fetal life and not to improper tying of the cord. 
The treatment has already been described in a previous 
chapter on "The Care of the Cord.'" 

Hiccoughs. — Hiccoughs are very annoying to the 
baby. A few grains of granulated sugar placed on 
the tongue will dissolve and trickle down the throat 
and usually relieves this distressing condition. 

Thursh. — Thursh is an infection of the mouth and 
is caused by uncleanliness. and should not occur. It 
is always due to neglect. If baby's mouth is washed 
carefully after each feeding, with a solution of boric 
acid or a little bicarbonate of soda solution, this con- 
dition would never occur. 

Engorgement of the Breast. — A peculiar condition 
which sometimes affects children during the first three 

weeks of life, is an assumption of a function similar to 
lactation in the mother. The secretion closely re- 
sembles colostrum, and may be found in the mammary 
glands of babies of either sex. The nurse should not 
attempt to squeeze the milk out. as any existing in- 
flammation would be aggravated by so doing. 

Treatment. — For such a condition dress the glands 
with a little camphorated oil. over this a pad of ab- 
sorbent cotton : a little bandage is placed around over 
the pads to prevent them from slipping, or simply 
hold them in place by pinning them with a small 
safety pin to the little shirt. This is usually all the 
treatment that is necessary. The condition disappears 
in a few days. 

Vaginal Discharge. — Little girl babies sometimes 
have a little whitish mucus discharge from the vagina. 



This is of little importance ; the only treatment is 
cleanliness. 

Menstruation. — In rare cases the female child has a 
discharge resembling menstruation. It usually has no 
significance, yet should be reported to the physician. 

Size and Weight at Birth. — The average weight of 
a girl baby is seven and a half pounds to eight pounds, 
a boy from eight to nine pounds. The average length 
of a girl baby is from nineteen to twenty inches, and 
a boy from twenty to twenty-one inches. 

Teething — This is inserted simply for completness, 
and it may be a suggestion to some inexperienced 
nurse in caring- for such an infant. Keep the stomach 
and bowels in a good condition and there will be no 
cause for alarm. Should fever occur, it is usually 
caused by indigestion. The child swallows a great 
deal of mucus ; this is especially true of children that 
do not drool. Watch the bowels and character of the 
stools. If slimy, containing mucus and curds and are 
green, give a teaspoonful of castor oil or laxsol, and 
omit the food (if a bottle baby) for twenty-four 
hours and give barley water or albumen water. Where 
the teeth are very broad and thick and the gum tissue 
hard, it is better to have them lanced; it saves the 
little one much suffering. Do not allow the baby to 
suck its thumb ; it spoils the shape of its mouth, in- 
creases the flow of saliva, which causes indigestion and 
predisposes to adenoids. There are twenty teeth in 
the first set. The two central lower teeth are usually 
the first to appear. They are cut between the fifth 
and eighth month. Next are the four central upper 
teeth, which are cut between the eighth and tenth 
month. The other two lower central teeth and the 

.228 



four front double teeth between the twelfth and 
eighteenth month. Then the four canine teeth ; the 
two upper ones are known as eye teeth and the lower 
ones as the stomach teeth ; these usually come be- 
tween the eighteenth and twenty-fourth month. The 
four back double teeth, which complete the first set, 
come between the twenty-fourth and thirtieth month. 
The time of appearance of the teeth varies. In some 
families they come very early, in others late. 

Symptoms. — The symptoms of teething are fretful- 
ness, restlessness, loss of appetitie, drooling, indiges- 
tion, sucking or biting of the thumb or ringer and 
fever. Sometimes the teeth are large and the gum 
tissue very tough and hard, and the gums are lanced 
to assist nature, thus relieving the child of much suf- 
fering. During teething children frequently have 
convulsions. 

Convulsions. — The first thing noticed usually is a 
jerking and twitching of the limbs, the infant is restless 
and does not care for food. The first thing to be done 
is to keep the infant and surroundings quiet and notify 
the physician at once should a convulsion take place. 
While waiting for the physician, the nurse should 
give an enema of saline, to empty the baby's bowels, 
and two drops of syrup of epecac every twenty min- 
utes until vomiting is produced. Often convulsions 
are caused by indigestion. Place the baby in a hot 
mustard bath. The temperature of the bath for a 
baby in a convulsion is ninety-nine and a half. You 
can not reduce the temperature of the water below 
the normal temperature of the body. The baby is 
easily supported in the water by placing the hand 
under the back. The baby should remain in the water 
ten to fifteen minutes. Ice should be kept constantly 

229 



on its little head. There should be a tablespoonful of 
mustard to each gallon of water. When the convul- 
sion ceases add a little cold water. Have plenty of 
hot water for the physician when he arrives. 



230 



APPENDIX. 

The Life of the Nurse. 

"Oh may I join the choir invisible 

Of those immortal dead who live again 

In minds made better by their presence-live. 

In pulses stirred to generosity, 

In deeds of daring rectitude, in scorn 

For miserable aims that end with self. 

In thoughts sublime that pierce the night-like stars, 

And with their mild persistence urge men's search 

To vaster issues. . . . May I reach 

That purest heaven, be to other souls 

The cup of strength in some great agon}-. 

Enkindle generous ardour, feed pure love. 

Beget the smiles that have no cruelty — 

Be the sweet presence of a good diffused. 

And in diffusion ever more intense. 

So shall I join the choir invisible, 

Whose music is the gladness of the world." 

''Every noble life leaves the fibers of it interwoven 
into the frabic of the world." — Ruskin. 

The life of a trained nurse is one rilled with awe. 
hope and great responsibilities, yet a privileged and 
sacred calling. There is no more useful or nobler 
profession than the "trained nurse." She who cares 
tenderly and lovingly for the sick, suffering and dying, 
tills the noblest trust of woman. The good she has in 

231 



her power to do, the aching hearts and brows that she 
may soothe, the pain-stricken and mangled forms that 
she may handle gently and tenderly ; to her, indeed, 
is given a rare opportunity, a great privilege. The life 
and ministrations of a kind, gentle, sympathetic 
and conscientious nurse is a great blessing to suffer- 
ing humanity. She has many sacrifices to make, and 
many trials to contend with ; she will meet with many 
discouragements in serving the sick and suffering; 
her efforts and devotion to duty will not always be 
appreciated as they deserve, but she can be kind, 
faithful, true and attentive and know the peace and 
joy that comes with the knowledge of duty well done. 
This is , and should be, her true and real compensation. 
For gold or honor can never repay a nurse for the 
services she renders, the sacrifices she makes or the 
dangers she braves in serving suffering humanity. 
But should she meet with ingratitude, let it not deter 
her on her upward march, let it not cause her to hesi- 
tate or falter, but rather stimulate and strengthen her 
to walk faithfully and honorably in the noble profes- 
sion she has chosen and be an ornament thereto. Let 
her, too, recall all those big brown and blue eyes that 
have looked up to her from their ivhite pillow of pain 
with love, gratitude and hope and she will feel she is 
more than compensated for any ingratitude she may 
meet, and finally what a rich reward in heaven will be 
the lot of the faithful nurse. God is faithful to His 
promises. If He has promised to reward even a cup 
of cold water given in His name, what will be the re- 
ward of those who have spent their whole life in min- 
istering to the sick and suffering". The whole life of 
such a nurse has been one of continual sacrifice. But 
every step she has taken, every word of consolation 

232 



she has spoken, every service she has rendered, every 
wound she has dressed, every pain she has soothed all 
have been registered in the book of life by the record- 
ing angel, a true member of the "Choir invisible, a cup 
of strength in some great agon}"." 

A nurse's life work is one of sacrifice to God and hu- 
manity, and sacred in the eyes of both. 

The Duty of the Nurse Toward the Physician. — 

"Fill up each hour with what will last. 

Buy up the moments as they go : 
The life above, when this is past. 

Is the ripe fruit of the life below." 

The nurse and the physician should have entire con- 
fidence in each other in order that satisfactory results 
may be obtained. The nurse should always be loyal 
to the physician in charge, and scrupulously faithful 
in earning out his orders and treatments loyally and 
faithfully, without modifying or changing them in 
any way. If a nurse by her conduct or words shows a 
want of confidence in the attending physician, it may 
be a means of destroying all confidence between the 
physician and patient. Never by word or look cast a 
reflection upon the ability of the attending physician ; 
speak with confidence in his skill and ability to handle 
the case, and the nurse should impress upon her pa- 
tient the importance of relying upon the doctor's skill 
and following- his directions implicitly. Never bv 
word or look cast a reflection of a doubt as to his 
ability to handle the case. Xowhere is faith more 
necessary than in the sick room. Without this confi- 
dence the doctor can do but little, the patient is made 
miserable, and often life depends upon it. The 
methods of one physician may differ somewhat from 
the methods of another, but both obtain uniformly 

233 



good results. A nurse may think what she chooses. 
but never question the physician's methods. The nurse 
acting as his assistant, is bound to carry out his 
treatments loyally and faithfully without modifying or 
changing them in any way. She should be broad and 
just adhere loyally to the methods prescribed by the 
attending physician. She should remember she is a 
nurse and not a physician, and not assume responsi- 
bilities that do not belong to her; moreover, if she fol- 
lows and carries out loyally the orders of the physician, 
she has done her duty, and is not to be held responsi- 
ble for untoward results. 

Be frank with the physician. The nurse should con- 
sider no symptom too small or trivial to consult him 
about. He will appreciate it and trust her. The phy- 
sician relies on the nurse in observing and recording 
the symptoms, and on the information thus obtained 
lie often bases his diagnoses and prognoses. He as- 
signs to the nurse exclusively the duty to carry his 
treatments into effect, and in so doing he feels as- 
sured that his patient is in safe hands. 

Keep an accurate record of all symptoms. Do not 
consider anything too trivial to make a note of; better 
err by making your notes too full than omit something 
which you ma}' consider small but which may have 
an important bearing on the case. Be careful of the 
little things : they mean so much both to the success- 
ful issue and comfort of your patient. Above all else 
inspire the patient and the patient's family with con- 
fidence in the attending physician by your words, man- 
ner and loyalty to him. It is not so much through 
any actual words that the nurse inspires the patient 
and friends with confidence in the attending physician 
as the manner in which she receives his orders 

234 



and her readiness in carrying- them out, all of which 
are readily intercepted by anxious friends. A nurse 
should never show by her manners towards the phy- 
sician any shadow of rudeness, even, although she 
should have but little respect for him or his ways. If 
a nurse knows full well, beyond the shadow of a doubt, 
the physician is not doing his duty, either because he 
is ignorant or indifferent, and she can not consci- 
entiously remain under his direction or carry out his 
treatment. Under these circumstances it would be 
wrong for her to continue on the case ; it would reflect 
on her character and she would become a party to mal- 
treatment. In such a case tell the physician frankly 
you can not continue on the case and your reasons 
why, and for the patient's safety suggest to the family 
or friends the necessity of calling in some other phy- 
sician in consultation. If for any can^e a nurse is 
obliged to oppose the doctor, guard against doing it 
in the presence of a third party, or in the hearing of 
the patient. Always some distance from the patient's 
room. Any special feature in the case or regarding 
the patient, the nurse should make an opportunity 
for speaking to the doctor about them outside of the 
patient's room. And at the conclusion of the visit, 
after all orders and instructions have been given the 
nurse by the physician, the nurse should retire for 
a few minutes and leave the patient alone with the 
physician so that she may have an opportunity to sav 
anything she wishes to tell him in private. 

Be honest with the physician. "Honesty is the best 
policy" and a priceless virture in all walks of life, but 
especially is it so in the nursing profession. Be honest 
then with the physician. If you neglect to carry out 
an order or treatment, or make a mistake, have the 

235 



moral courage to tell him. None are so perfect that 
mistakes are impossible. All may make a mistake. In 
acknowledging a mistake the nurse will gain the con- 
fidence and respect of the physician. In trying to hide 
a mistake or omission she can not fail but to create a 
doubt and mistrust which no matter how faithful 
she may be in the future, she can never efface. 

The nurse's duty to the physician, then, consists in 
loyalty to him, in carrying out his orders, observing 
carefully everything and reporting same to him, and 
cordial relations cannot fail to be established between 
physician and nurse when the latter proves herself to 
be. his faithful and loyal assistant, and he in his turn 
shows, by his manners and address, his confidence in 
and his respect for her. 

The Nurse and Her Patient. — 

"Ask of God to give thee skill 

In comfort's art, 
That thou may'st consecrated be 

And set apart 
Unto a life of sympathy : 
For heavy is the weight of ills 

In every heart 
And comforters are needed much 
Of Christ-like touch." 

All things whatsoever ye would that men should do 
to you, do you even so to them. — Matthews vii, 12. 

We have selected as a means of livelihood nursing 
as a profession, and a noble profession it is, sacred in 
the eyes of God and man. Nursing is a vocation for 
which every one is not adapted, particularly this deli- 
cate branch of the profession. Tact, courtesy, adapt- 
ability, power of invention, unselfishness, sympathy, 

236 



kindness, refinement of character, common sense and a 
love of her profession are characteristic of the true 
nurse, and great is her power for good. When sum- 
moned to attend a case of illness it is well for the nurse 
to remember that hers is a mission of mercy, and that 
it is her duty to bring fortitude, courage and hope into 
the afflicted home where dread and fear dwell. She 
must bring hope and cheerfulness into the sick room 
by her gentle looks, kindly pleasant smiles and softly 
uttered words. She should be dignified yet modest, 
gentle, kind and sympathetic, yet firm and determined 
when necessary. If she could only remember to fol- 
low in every instance the golden rule, to do unto her 
patients even as she would have done unto herself, 
or unto one of her own loved ones, she would not be 
apt to make many mistakes. From the moment a 
nurse enters a home, she should endeavor to win the 
confidence of her patient and the family. Many sick 
persons object to a trained nurse because of fear that 
their loved ones will be banished from the sick room. 
The family should not be denied the privilege of the 
sick room, or restrictions placed on their visits unless 
it is the order of the attending physician, or when the 
nurse sees it is harmful to the patient ; then she should 
tell the physician, and he will give orders accordingly. 
A nurse should avoid showing any marked authority ; 
always give due consideration to any suggestion of- 
fered, and give way to any wishes respecting the pa- 
tient, when such a course would not be harmful. A 
nurse should so conduct herself that the family will 
gradually learn to lean on her and feel before many 
days she is indispensible. She should be tactful, evade 
questions when she finds it necessary, but should not 
be mysterious in her actions. A simple explanation 

237 



will often allay great fears. She should guard the in- 
terests of the patients intrusted to her, that her high 
mission in life may be fulfilled. Secrets even dearer 
than life itself will often be instrusted to her keeping. 
In all homes there are secrets. A nurse should remem- 
ber in entering the private sanctuary of a home, to 
keep her eyes open and her mouth closed. "Silence 
is golden." Shakespeare says, "Give thy thoughts no 
tongue." If she finds disease lurking where she did 
not expect to find it, if she hears the rattle of the bones 
of the skeleton in the closet, she should remember her 
trust is a sacred one and what she may have heard or 
seen on these occasions in this confidential capacity 
should be held as sacred and in the strictest confidence. 
A nurse should never gossip. Avoid it as she would 
poison, for it will be to her a deadly poison if she 
does. To refrain from this is, I am sure, more easily 
said than done, for the strongest temptation generally 
comes from the patients themselves. But a nurse 
should be no tale-bearer. She should never mention 
the family affairs of any patient. People do not care 
to hear the praises of others sung continuously or 
hear of their faults. It is true, at the time, the enquirer 
may be amused or entertained; but sooner or later 
those friends will distrust her, they will think, if she 
talks about Mrs, B. to me, she will talk of me to others. 
A nurse can not accept these confidences and betray 
them and continue honest, and the contempt and 
failure she so richly deserves will be her portion. 
Perhaps the best way, after all. will be for the nurse 
to meet the issue frankly and say she feels it to be a 
matter of duty never to talk about her patients ; it 
is true the enquirer may feel a little hurt or annoyed 
by the refusal, but in her heart she must confess the 

238 



loyalty which refuses to discuss professional affairs is 
highly commendable, and she will respect the nurse 
for it, A nurse should be a woman of character, with 
purity of life and speech. The sick room is no place for 
vulgar jest. The life of a nurse should be most circum- 
spect and honorable. Her life enters into and bears 
a closer relation to the life of the patient than she 
may think. Her position at the bedside of the sick 
gives her a license to converse on subjects not men- 
tioned in mixed audiences. She should use the privi- 
lege fearlessly and without coyness, but when the 
threshold of the sick room is crossed, she should re- 
member she is a woman and let her conversation be 
in keeping with her sex. With all men with which 
she may be brought into contact in the performance 
of her duty, physicians, the patient or his family, she 
should maintain always a courteous but strictly profes- 
sional impersonal attitude. Be gentle in word and 
action, and faithful in the performance of her duty. 
Always remembering she has the highest mission in- 
trusted to her. She should be faithful to her trust and 
true to her womanhood. She should have a heart so 
as to be a blessing to her patient and the family. A 
mechanical nurse is a failure. Always remembering 
that sympathy and kindness are twin virtures which 
must be possessed by even r nurse who wishes to make 
a success of her calling and accomplish the vast 
amount of good that lies within her power in the 
broad field she has chosen for her life's work, and 

"When the lessons of life are all over 

And the Master says our school is dismissed, 

May we all meet in heaven together, 
Not one of our number be missed." 



239 



INDEX 



Abdomen in pregnancy....... 41 

pigmentation of 42 

Abdominal binder 31 

in pregnancy 31 

in puerperal 103 

Abortion, time most lkely to 

occur 32 

Abscess of the breast 156 

Airing 191 

Albumenuria 33 

Anesthesia 90 

Anesthetic, administering of, 
in second stage of la- 

bor ....90-91 

Anatomy of the pelvis 17 

Anus, occlusion of 217 



oS 



Areola of pregnancy 

Areoias signs in diagnosis of 

pregnancy 

Articles necessary for the 

baby's bath 1*3 

Articles necessary for obstet- 
rical cases 51 

Asphyxia neonatorum 209 

Atelectasis 213 

Babies, blue 2 J3 

Babies, nervous J-»s 

Baby, how to bathe the 1<5 

dress the |8d 

feed the 199 

lift and carry the 187 

often to nurse the 123 

how to put the. to sleep... 184 

kissing the 188 

weaning the 20 7 

feeding the 119 

Bag, the nurse's obstetrical.. 60 

Bands, the infant 54 

Bandage, the occlusion 104 

Baptism of the baby 96 

Bath for the baby 174 

for premature or delicate 

child 174 

Bed of incubator 213 

a baby's 184 

preparation of the, for la- 
bor 77 

how to change the pa- 
tient's 129-130-131 I 



Bed pan 127 

Binder, breast 125 

Bladder, 

during pregnancy 43 

after delivery 108 

during puerium 161 

Blanket for the reception of 

the baby 81 

Bones, os innominata 18 

Bleeding 107 

Bottles, the 205 

how to prepare the 202 

filling the 203 

Bowels, 

in pregnancy 33-43 

in puerperium Ill 

in infancy 188 

in the new-born babe 217 

Breast, Abscess of the 156 

asepsis of the, during puer- 
perium 115 

changes in, during preg- 
nancy 40 

care of the, during lacta- 
tion 118 

engorgement of the, in 

puerperium 154 

enlargement of the, in the 
diagnosis of pregnancy.. 38 
enlargement of the, in 

pregnancy 40 

enlargement of the, in the 

new-born infant 227 

inflammation of the 156 

Breech delivery 140 

Care of the baby. 170-171-172-173 

Care of the cord 179 

eyes 177 

genitals 181 

nails 182 

navel 179 

mouth 177 

Catheterization in puerper- 
ium 109-110 

Changes in the maternal 
organs caused by preg- 
nancy 40 

Changes in the abdomen... 41 



240 



INDEX — Continued. 



Changes in the bladder 43 

in the blood 40 

in the bowels 43 

in the breast 40 

in the heart 40 

in the liver 44 

in the spleen 44 

in the uterus 43 

in the veins 43 

Chill after labor 160 

Chills 164 

Chloroform, how to adminis- 
ter the 90 

Circumcision 215-216-217 

Clean, keep the baby 208 

Cleanliness of the patient 

during- puerperium 112 

Cleanliness, vaginal 35 

Clothing of the baby 182 

of the mother during preg- 
nancy . . 31 

Colic 225 

Colostrum 38 

Complications during labor. ..132 
management of the birth 
of the child in the absence 

of the physician 132-140 

eclampsia 148 

hemorrhage 144 

prolapse of the cord 143 

Complications of the puer- 
perium 150 

engorgement of the breast. 154 
tissues and cracks of nip- 
ples 156 

mastitis 156 

puerperal insanity 157 

paralysis 158 

septic phlebitis 158 

subinvolution 159 

sepsis 150 

Conception 26 

Constipation in the baby 217 

in pregnancy 33 

in puerperium Ill 

Contractions uterine 10~7 

Convulsions 229 

"Cord, tying the 93-95-137 

the umbilicus 22 

Corset in pregnancy 31 

Cough 44 

Cramp in leg 89 

Decidua 21 

Delivery of the placenta 139 

Diaper, 

material for 54 

Diet for infants 192 

in pregnancy 29 

in puerperium Ill 



Difficulty in nursing 223 

Discharge, vaginal, 

during pregnancy 35 

during puerium 162 

of the new-born 227 

Diseases, contagious 36 

Doctor, preparation for, in 
the first stages of labor.. 79 

Douche, after labor 100 

Dress for incubator 214 

in pregnancy 31 

Dressings, vulva 112 

Drink during pregnancy 30 

Duration of pregnancy 48 

Duties of her friends 47 

Duties of the nurse after the 

arrival of the doctor 84 

Duties of the nurse towards 

the physician 233 

Eclampsia 148 

Edema of the extremities- 

during pregnancy 43 

Exercise for the baby 185 

Eyes, 

care of the infant's 177 

application of ice to the... 219 

infection of the 218 

irrigation of the 221 

new-born, care of the 177 

Feeding the baby 119 

breast ng 

artificial 195 

mixed 124 

Fetus in uterus, position of.. 82 

Fluid, the amniotic 22 

Food 192 

for the baby 192 

how to prepare the 200 

appliances needed for the 

preparation of the 201 

materials needed for the 

preparation of the 200 

formulas for the prepara- 
tion of the 195-196-197 

Foods, other 206 

Glands, mammary 25 

Hands, sterilization of the... 58 

Heart, the fetal 45 

Heart, the mother's 40 

Hemorrhage, general direc- 
tion 144 

of abortion 148 

recurring 147 

placenta praevia 145 

post-portum 146 

secondary 148 

umbilical 214 

symptoms of 1 48 

Hernia, umbilical 227 



241 



INDEX— Continued. 



Hiccoughs 

Hygiene of pregnancy. 

Inhaler, to make 

Ills of baby , 

Impressions, nervous . 



227 

28 

92 

209 

, 46 



Incubator, improvised 213 

my ....213-214 

Indigestion 225 

Infection of the eyes 218 

Insanity, puerperal 157 

Instruments . 87 

Involution 107 

Jaundice, of the new-born. . .217 

Kidneys in pregnancy 33 

in puerperium 161 

of the baby 190 

Labor 59 

preparation for 60 

toilet of the patient for 69 

dry 74 

first stage of 67 

care during 69-72 

nurse's duties during first 

stage of 69-82 

Second stage of 72 

care during second stage 

of 72-93 

rupture of the amniotic 

sack 68-69 

show as a sign 68 

cramps in the leg 89 

third stage of 97 

care during third stage 

of 98-99 

expelling placenta 99-100 

guarding the uterus in the 

third stage 98 

care and toilet of the pa- 
tient after 102-103 

temperature and pulse af- 
ter 105 

nourishment after 106 

sleep after 106 

Lacerations 101 

Language of the baby... 185 

Cry of habit ...186 

hunger 186 

illness 186 

pain 186 

temper 186 

cry, normal 186 

Light and heat in the lying- 
in room 55 

Lightening 44 

Life of the nurse 231 

Lochia, the 162 

Lungs during pregnancy 29 



Management of the birth of 
the child in the absence 

of the physician 132 

Mastitis 156 

Method of Dr. Arthur N. 

Curtis 117 

Menses, cessation of in diag- 
nosis of pregnancy 38 

Menstruation, in the new- 
born 228 

Milk, alkalinity of, method of 

obtaining 194 

constituents of ...193 

to dry up the 125 

to decrease the flow 125 

to increase the flow 124 

to modify 193 

table giving the constitu- 
ents of mother's and 

cow's milk 193 

to heat 204 

to tell good 204 

to pasteurize 204 

to sterilize ...204 

Milk sugar 203 

Mind, in pregnancy 46 

Navel, care of ..179 

Nipple, care of the 35 

cracks of the.. 156 

tissues of the.. 156 

inverted 117 

care during pregnancy 35 

care during puerperium. .. .116 

Nipple, shield 117 

Nipple, rubber 205 

Nurse, the obstetrical 50 

Nurse and her patient. 236 

Nurse, wet 206 

Nursing the baby .118 

Occupation during pregnancy 36 

Operation, forcep .167 

Operation, obstetrical ...165-166 

Ophthalmic neonatorum 218 

Organs of generation 17 

Outfit for the baby... 53-54 

Outfit for mother and child.. 51 
Outfit for the mother.. ..51-52-53 

Ovaries, the 20 

Pad, a good labor 78 

Pains, 

after 104 

bearing-down €6 

false and true 66 

false 67 

true 66 

Paralysis 158 

Perineorrhaphy 166 



242 



INDEX— Continued. 



Pereneum, to assist the doc- 
tor in preserving the 93 

Period, the convalescing 126 j 

the lying-in 126 

the puerperal 1C6 

Phlebitis, septic 158 

Points of special interest dur- 
ing puerperium 160 I 

daily toilet of the pa- 
tient 126-127-128 

abdomen 161 

appetite 161 

bladder and bowels 161 | 

breast 163 

lochia 162 

laceration 163 

pulse 161 

skin 161 

sleep 160 

temperatuie 161 

time of getting up 126 

uterus 161 

ventilation 115 

visitors during 112 

chill after labor 160 

Positon of the child in the 

uterus 82-83-84 

of the mother when nurs- 
ing the child 120 

when lying down 120 

when sitting up 121 

of the patient after labor.. 106 

Pregnancy 26 

appetite during 29 

bathing 32 

bleeding 36 

exercise 32 

nausea 37 

sleep 29 

teeth 34 

urine 32 

bowels 33 

kidneys 33 

Preparation for the doctor... 79 

for forcep delivery 96 

of the patient for examina- 
tion 85 

of the patient for internal 

examination 85 

of the patient for external 

examination 85 

for the recerjtion of the 

baby . 81 

Presentation 

Arm or transverse 142 

breech 140 

head 134 

other 140 

Pulse of the baby 188 

Quickening 45 

Recognition of labor 65 

Record of the nurse 164 

Regularity of habit 190 



Regularity in nursing 121 

Reins, direction for making 

the . , 78 

Respiration. 

artificial 212 

Bird's method 212 

Sylvester's method 212 

simple method 210 

shock 210 

another method 212 

of the baby 188 

of the mother during preg- 
nancy 45 

Room, selection of the 55 

Sack, the placental 22 

Section, Cesarian 169 

Sepsis 150 

Sickness, morning, diagnosis 

of pregnancy 37 

Size and weight at birth 228 

Sleep of the baby 183 

Sterilization, method of 

basins 57 

brushes 57 

bed pans 57 

dressings 56 

gloves 57 

douche bags 57 

gowns 56 

labor pads 56 

hands 58 

instruments 57 

Stools of the baby 189 

artificially fed 189 

breast fed 189 

character of the 189 

causes of dark 1 R 9 

of the new-born infant. .. .189 

Subinvolution 159 

Supervision, medical 26 

Sutures 114 

Swelling 35 

Svmptoms of pregnancy 37 

first 37 

second 38 

third 38 

fourth . 38 

positive 38 

relative value of 38 

System, the nervous 46 

Teething 228 

Temperature of the baby.... 187 
of the bath for the baby. . .174 

of the room 174 

Tetanus 226 

Thrush 227 

Tubes, fallopian 23 

Umbilicus, infection 226 



243 



INDEX— Continued. 



Urine, passing , . 
Urination delayed 
Uterus, the 



108 

215 

23 

Vagina, the 24 

Veins, varicose 13 

Ventilation 115 



Version 168 

Vomiting 224 

Visitors 112 

Vulva, the 24 

Water for the baby 207 

Weight of baby 207-208 



244 



